Provider Demographics
NPI:1285884759
Name:VIVIAN W BUCAY MD PLLC
Entity type:Organization
Organization Name:VIVIAN W BUCAY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:FREEHAUF
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:830-931-5582
Mailing Address - Street 1:326 W CRAIG PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3307
Mailing Address - Country:US
Mailing Address - Phone:210-692-3000
Mailing Address - Fax:210-692-3056
Practice Address - Street 1:326 W CRAIG PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3307
Practice Address - Country:US
Practice Address - Phone:210-692-3000
Practice Address - Fax:210-692-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3955207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A3417Medicare PIN