1831330422 NPI number — MR. BOID BUIE

Table of content: MR. BOID BUIE (NPI 1831330422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831330422 NPI number — MR. BOID BUIE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUIE
Provider First Name:
BOID
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831330422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1660 W MISSION BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91766-1200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-469-4500
Provider Business Mailing Address Fax Number:
909-469-9563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9150 IMPERIAL HWY RM P-31
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90242-2835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-940-3694
Provider Business Practice Location Address Fax Number:
562-658-7425
Provider Enumeration Date:
03/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: '17' . This is a "OTHER SERVICE PROVIDERS" identifier . This identifiers is of the category "OTHER".




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