Basic Information
| Provider Information | |||||||||
| NPI: | 1003174921 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENERAL PHYSICIAN SUB II PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8000 | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142408000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039441940 | ||||||||
| FaxNumber: | 2034024192 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HIGH ST | ||||||||
| Address2: | RM C421 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142031126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168597607 | ||||||||
| FaxNumber: | 7168592885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2012 | ||||||||
| LastUpdateDate: | 09/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | HUGHES | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7168597607 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GENERAL PHYSICIAN, PC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.