Healthcare Provider Details

I. General information

NPI: 1336357102
Provider Name (Legal Business Name): LLOYD S. BUXBAUM CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E GIRARD AVE STE 250
ENGLEWOOD CO
80113-2784
US

IV. Provider business mailing address

5946 E JUNIPER AVE
SCOTTSDALE AZ
85254-9225
US

V. Phone/Fax

Practice location:
  • Phone: 720-214-2549
  • Fax: 303-744-7876
Mailing address:
  • Phone: 602-595-3598
  • Fax: 602-595-3598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number289
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: