1750375408 NPI number — DR. BENJAMIN BUJANDA MD

Table of content: DR. BENJAMIN BUJANDA MD (NPI 1750375408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750375408 NPI number — DR. BENJAMIN BUJANDA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUJANDA
Provider First Name:
BENJAMIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1750375408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/05/2006
NPI Reactivation Date:
04/12/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 S 5TH ST
Provider Second Line Business Mailing Address:
SUITE 119
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78503-2927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-682-8343
Provider Business Mailing Address Fax Number:
956-682-8367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 S 5TH ST
Provider Second Line Business Practice Location Address:
SUITE 119
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78503-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-682-8343
Provider Business Practice Location Address Fax Number:
956-682-8367
Provider Enumeration Date:
09/08/2005

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: 207Q00000X , with the licence number:  E6006 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00AF78 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00AF78 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 31849501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012900700 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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