Provider Demographics
NPI:1063793776
Name:PAUL R. BUITRON, M.D., P.A.
Entity type:Organization
Organization Name:PAUL R. BUITRON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:BUITRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-724-1508
Mailing Address - Street 1:220 W. HILLSIDE RD SUITE 13
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:956-724-1508
Mailing Address - Fax:956-717-1041
Practice Address - Street 1:220 W. HILLSIDE RD. SUITE 13
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-724-1508
Practice Address - Fax:956-717-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2182207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099468301Medicaid
TXB31566OtherBC/BS UPIN
TX099468301Medicaid