Provider Demographics
NPI:1538935143
Name:BUFMACK, LUCAS
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:BUFMACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 LONESTAR PARK LN
Mailing Address - Street 2:
Mailing Address - City:PONDER
Mailing Address - State:TX
Mailing Address - Zip Code:76259-8476
Mailing Address - Country:US
Mailing Address - Phone:719-429-1132
Mailing Address - Fax:
Practice Address - Street 1:2250 HIGHLAND VILLAGE RD STE 200
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7188
Practice Address - Country:US
Practice Address - Phone:972-317-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program