1972663938 NPI number — SCOTT DAVID BUIS P,A,-C

Table of content: SCOTT DAVID BUIS P,A,-C (NPI 1972663938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972663938 NPI number — SCOTT DAVID BUIS P,A,-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUIS
Provider First Name:
SCOTT
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P,A,-C
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:
1972663938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3941 SAN DIMAS ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93301-5734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-324-6593
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 BLACKSTONE CT
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93304-5401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-324-6593
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2006

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: 363A00000X , with the licence number:  PA13789 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PA13789 . This is a "CALIFORNIA STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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