Provider Demographics
NPI:1679523658
Name:BUENO, JOSE DOMIL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:DOMIL
Last Name:BUENO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:808 TOWER DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4269
Mailing Address - Country:US
Mailing Address - Phone:432-580-4170
Mailing Address - Fax:432-580-4091
Practice Address - Street 1:808 TOWER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4269
Practice Address - Country:US
Practice Address - Phone:432-580-4170
Practice Address - Fax:432-580-4091
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ9635208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110667601Medicaid