MEDICARE: DR. FREDERICK JOEL BUCKWOLD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	F2572	TX

General Provider Information

NPI Number	:	1427125004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK JOEL BUCKWOLD M.D.

Provider Business Mailing Address
First Line	:	4028 GRAMERCY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-1109
Country	:	US
Telephone Number	:	713-666-9004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 E GREENWAY PLZ
Second Line	:	SUITE 500
City	:	HOUSTON
State	:	TX
Zip	:	77046-0297
Country	:	US
Telephone Number	:	713-479-4480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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