Provider Demographics
NPI:1679882690
Name:BUIE, RONALD WILLIAM (LAC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WILLIAM
Last Name:BUIE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6682 HIGHWAY 11
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-7554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6682 HIGHWAY 11
Practice Address - Street 2:SUITE 103
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-7554
Practice Address - Country:US
Practice Address - Phone:601-749-4939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAC00014171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist