Healthcare Provider Details

I. General information

NPI: 1811079304
Provider Name (Legal Business Name): RODGER K. BUFFORD PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 SW BEVELAND STREET
TIGARD OR
97223
US

IV. Provider business mailing address

7455 SW BEVELAND STREET
TIGARD OR
97223
US

V. Phone/Fax

Practice location:
  • Phone: 503-624-2600
  • Fax: 503-624-7752
Mailing address:
  • Phone: 503-624-2600
  • Fax: 503-624-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number526
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: