Basic Information
| Provider Information | |||||||||
| NPI: | 1578787024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUI | ||||||||
| FirstName: | BAO-ANH | ||||||||
| MiddleName: | NGOC | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2582 | ||||||||
| Address2: | |||||||||
| City: | BRYSON CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287132582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102398100 | ||||||||
| FaxNumber: | 8285384441 | ||||||||
| Practice Location | |||||||||
| Address1: | 1756 METROMEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283043861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104858831 | ||||||||
| FaxNumber: | 9104858832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 05/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2009-01251 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01034103 | 01 | NC | RAILROAD MEDICARE | OTHER | 2075474B | 01 | NC | MEDICARE PTAN | OTHER |