Healthcare Provider Details

I. General information

NPI: 1821188905
Provider Name (Legal Business Name): KEVIN BUFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1396 N WATERMAN AVE
SAN BERNARDINO CA
92404-5313
US

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER, UNIT 33100
APO AE
09180-3100
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-8350
  • Fax:
Mailing address:
  • Phone: 314-590-8350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number052899
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-17658
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number52899
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number052899
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberC202394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: