Jose Domil Bueno, M.D.
Individual provider Active NPI Pediatrics Physician · Odessa, TX
NPI 1679523658 · NPPES record last updated Apr 22, 2022
Key facts
- NPI
- 1679523658
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- J9635 (TX)
- Practice address
- 808 Tower Dr
Suite 1
Odessa, TX 79761-4269 - Phone
- (432) 580-4170
- Fax
- (432) 580-4091
- NPI assigned
- May 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J9635 | TX | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Odessa Texas Hospital Company LLC | Past | Accepting new patients | |
| Jose D Bueno, M.D.,P.a. | Pediatrics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | J9635 | TX | Yes |
Addresses
Primary practice location
808 Tower Dr
Suite 1
Odessa, TX 79761-4269
Mailing address
808 Tower Dr
Suite 1
Odessa, TX 79761-4269
Phone (432) 580-4170
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110667601 | Medicaid | TX |
Other providers in Odessa, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.