Healthcare Provider Details

I. General information

NPI: 1326075391
Provider Name (Legal Business Name): ROBERT NEAL BUFFALOE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S CHURCH ST
FAYETTE MO
65248
US

IV. Provider business mailing address

PO BOX 7687
COLUMBIA MO
65205-7687
US

V. Phone/Fax

Practice location:
  • Phone: 660-248-2217
  • Fax: 660-248-3450
Mailing address:
  • Phone: 573-882-2259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20120036972
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: