Provider Demographics
NPI:1548816721
Name:BUFFALO FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:BUFFALO FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:903-388-1058
Mailing Address - Street 1:PO BOX M
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:TX
Mailing Address - Zip Code:75831-0317
Mailing Address - Country:US
Mailing Address - Phone:903-322-1290
Mailing Address - Fax:903-322-1304
Practice Address - Street 1:1686 W US HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:TX
Practice Address - Zip Code:75831-3490
Practice Address - Country:US
Practice Address - Phone:903-322-1290
Practice Address - Fax:903-322-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty