MEDICARE: BUCKINGHAM CENTER FOR FACIAL PLASTIC SURGERY PA

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	K5468	TX
2	207Y00000X	Otolaryngology Physician	K5468	TX
3	207YS0123X	Facial Plastic Surgery Physician	K5468	TX
4	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	K5468	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0003NL	OTHER	TX	BCBS OF TEXAS GROUP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770554800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKINGHAM CENTER FOR FACIAL PLASTIC SURGERY PA

Provider Business Mailing Address
First Line	:	2745 BEE CAVES RD
Second Line	:	SUITE 101
City	:	AUSTIN
State	:	TX
Zip	:	78746-5640
Country	:	US
Telephone Number	:	512-401-2500
Fax Number	:	512-401-2501

Provider Business Practice Location Address
First Line	:	2745 BEE CAVES RD
Second Line	:	SUITE 101
City	:	AUSTIN
State	:	TX
Zip	:	78746
Country	:	US
Telephone Number	:	512-401-2500
Fax Number	:	512-401-2501

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD DEAN BUCKINGHAM
Credential	:	MD
Telephone Number	:	512-401-2500

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	05/21/2018

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Directions to “BUCKINGHAM CENTER FOR FACIAL PLASTIC SURGERY PA ” Practice Location

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