Basic Information
| Provider Information | |||||||||
| NPI: | 1568629970 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUFORD | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7373 ARDMORE ST | ||||||||
| Address2: | 1456 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770544213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018072344 | ||||||||
| FaxNumber: | 7137981144 | ||||||||
| Practice Location | |||||||||
| Address1: | 7373 ARDMORE ST | ||||||||
| Address2: | 1456 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770544213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018072344 | ||||||||
| FaxNumber: | 7137981144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2008 | ||||||||
| LastUpdateDate: | 02/21/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 753580 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1950693-02 | 05 | TX | MEDICAID |