Provider Demographics
NPI:1245310416
Name:BUCY, ROBERT LANHAM
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LANHAM
Last Name:BUCY
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 1:5821 CORONADO RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4245
Mailing Address - Country:US
Mailing Address - Phone:915-585-9714
Mailing Address - Fax:915-593-4028
Practice Address - Street 1:1533 N LEE TREVINO DR
Practice Address - Street 2:SUITE C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5170
Practice Address - Country:US
Practice Address - Phone:915-593-5057
Practice Address - Fax:915-593-4028
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM18561223P0106X
TX116311223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD11631Medicare ID - Type Unspecified
TXT-12447Medicare UPIN