Healthcare Provider Details

I. General information

NPI: 1013095272
Provider Name (Legal Business Name): DOUGLAS F BUXTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 14TH STREET ROOM 403
NEW YORK NY
10003-4201
US

IV. Provider business mailing address

310 E 14TH STREET ROOM 403
NEW YORK NY
10003-4201
US

V. Phone/Fax

Practice location:
  • Phone: 212-979-4410
  • Fax: 212-353-5772
Mailing address:
  • Phone: 212-979-4410
  • Fax: 212-353-5772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1567831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: