MEDICARE: DR. JOE LEE BUFORD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	C5376	AR
2	208D00000X	General Practice Physician	C5376	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57813	OTHER	AR	PTAN

General Provider Information

NPI Number	:	1942360052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOE LEE BUFORD MD

Provider Business Mailing Address
First Line	:	410 W PERSHING BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2146
Country	:	US
Telephone Number	:	501-771-0674
Fax Number	:	501-753-4147

Provider Business Practice Location Address
First Line	:	410 W PERSHING BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2146
Country	:	US
Telephone Number	:	501-771-0674
Fax Number	:	501-753-4147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	12/20/2013

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