1558355586 NPI number — JOHN A BUIE MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558355586 NPI number — JOHN A BUIE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUIE
Provider First Name:
JOHN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558355586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/24/2006
NPI Reactivation Date:
04/04/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2169
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELK CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73648-2169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-821-1185
Provider Business Mailing Address Fax Number:
580-303-9166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 N ILLINOIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEATHERFORD
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73096-5437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-774-5089
Provider Business Practice Location Address Fax Number:
580-303-9166
Provider Enumeration Date:
09/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  18370 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 106938 . This is a "BLUE CROSS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200538650A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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