Healthcare Provider Details

I. General information

NPI: 1922288018
Provider Name (Legal Business Name): GARY BERNARD BUFF ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5751 KUAKINI HWY STE 101 A
KAILUA KONA HI
96740-1752
US

IV. Provider business mailing address

75-5751 KUAKINI HWY STE 203
KAILUA KONA HI
96740-1752
US

V. Phone/Fax

Practice location:
  • Phone: 808-326-5629
  • Fax: 808-329-5057
Mailing address:
  • Phone: 808-326-5629
  • Fax: 808-329-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY 1022
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: