Basic Information
| Provider Information | |||||||||
| NPI: | 1932505419 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENERAL PHYSICIAN SUB III PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8000 DEPARTMENT 540 | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142670002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039441940 | ||||||||
| FaxNumber: | 2034024192 | ||||||||
| Practice Location | |||||||||
| Address1: | 1430 COLVIN BLVD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142231440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168744060 | ||||||||
| FaxNumber: | 7168740370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2014 | ||||||||
| LastUpdateDate: | 09/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | HUGHES | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7166922160 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GENERAL PHYSICIAN, PC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.