Provider Demographics
NPI:1487616785
Name:BAUKNIGHT, BRUCE (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:BAUKNIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 N LAURENT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5458
Mailing Address - Country:US
Mailing Address - Phone:361-572-0333
Mailing Address - Fax:361-371-7090
Practice Address - Street 1:6123 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1672
Practice Address - Country:US
Practice Address - Phone:361-578-1430
Practice Address - Fax:361-578-0876
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4925207RH0002X, 207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099421203Medicaid
TX8K1333OtherBLUE CROSS
TX099421204Medicaid
TX161169101Medicaid
TXP00039861Medicare PIN
TX161169101Medicaid
TX8F8884Medicare PIN
TX8F5798Medicare PIN
TX099421204Medicaid