Healthcare Provider Details

I. General information

NPI: 1558355586
Provider Name (Legal Business Name): JOHN A BUIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date: 03/24/2006
Reactivation Date: 04/04/2006

III. Provider practice location address

213 N ILLINOIS ST
WEATHERFORD OK
73096-5437
US

IV. Provider business mailing address

PO BOX 2169
ELK CITY OK
73648-2169
US

V. Phone/Fax

Practice location:
  • Phone: 580-774-5089
  • Fax: 580-303-9166
Mailing address:
  • Phone: 580-821-1185
  • Fax: 580-303-9166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number18370
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: