Provider Demographics
NPI:1477895282
Name:BUICKO LOPEZ, JESSICA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNN
Last Name:BUICKO LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:BUICKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12923 LOTT AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-1705
Mailing Address - Country:US
Mailing Address - Phone:518-229-7711
Mailing Address - Fax:
Practice Address - Street 1:11920 ASTORIA BLVD STE 460
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6155
Practice Address - Country:US
Practice Address - Phone:713-486-7650
Practice Address - Fax:865-328-0686
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137796208600000X
FLB200-432-87-867-0390200000X
TXU5081208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program