Healthcare Provider Details

I. General information

NPI: 1073778098
Provider Name (Legal Business Name): ROBERT B BUXTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 12TH AVE RD STE 200
NAMPA ID
83886
US

IV. Provider business mailing address

3340 E GOLDSTONE WAY
MERIDIAN ID
83642
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-6800
  • Fax: 208-302-6855
Mailing address:
  • Phone: 208-302-6800
  • Fax: 208-302-6855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-0639
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: