Healthcare Provider Details

I. General information

NPI: 1407940026
Provider Name (Legal Business Name): BUFORD HALL P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG ROAD SUITE A-540
LEXINGTON KY
40504
US

IV. Provider business mailing address

1401 HARRODSBURG ROAD SUITE A-540
LEXINGTON KY
40504
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-6760
  • Fax: 859-258-6512
Mailing address:
  • Phone: 859-258-6760
  • Fax: 859-258-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberPA218
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA218
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA218
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA218
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: