1831168301 NPI number — BUFFINTON B BURTIS MD

Table of content: BUFFINTON B BURTIS MD (NPI 1831168301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831168301 NPI number — BUFFINTON B BURTIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTIS
Provider First Name:
BUFFINTON
Provider Middle Name:
B
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:
BURTIS
Provider Other First Name:
BUFF
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1831168301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1047
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:
73648-1047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-225-8600
Provider Business Mailing Address Fax Number:
580-225-8603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1710 W 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 103B
Provider Business Practice Location Address City Name:
ELK CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73644-5159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-225-8600
Provider Business Practice Location Address Fax Number:
580-225-8603
Provider Enumeration Date:
03/16/2006

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: 207RP1001X , with the licence number:  1149 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MD1149 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 290004206 . This is a "RAILROAD" identifier . This identifiers is of the category "OTHER".




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