Provider Demographics
NPI:1154539146
Name:BUESO, FERNANDO JOSE JR (MDLSA)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:JOSE
Last Name:BUESO
Suffix:JR
Gender:M
Credentials:MDLSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 111938
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77293-0938
Mailing Address - Country:US
Mailing Address - Phone:713-882-9849
Mailing Address - Fax:
Practice Address - Street 1:4655 WILD INDIGO ST APT 274
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7076
Practice Address - Country:US
Practice Address - Phone:713-882-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLSA-05-168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant