Provider Demographics
NPI:1427125004
Name:BUCKWOLD, FREDERICK JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOEL
Last Name:BUCKWOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 GRAMERCY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1109
Mailing Address - Country:US
Mailing Address - Phone:713-666-9004
Mailing Address - Fax:
Practice Address - Street 1:2 E GREENWAY PLZ
Practice Address - Street 2:SUITE 500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-0297
Practice Address - Country:US
Practice Address - Phone:713-479-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2572207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease