Healthcare Provider Details

I. General information

NPI: 1487617791
Provider Name (Legal Business Name): PHILLIP GERALD BUFFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 HOSPITAL DR
MOUNTAIN HOME AR
72653
US

IV. Provider business mailing address

PO BOX 1449
MOUNTAIN HOME AR
72654-1449
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-1000
  • Fax: 870-424-3089
Mailing address:
  • Phone: 870-424-3181
  • Fax: 870-424-3089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC-7064
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC-7064
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: