Healthcare Provider Details

I. General information

NPI: 1063406114
Provider Name (Legal Business Name): BUFFY J COOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 OLD HWY 51 SUITE C
BRIGHTON TN
38011-7043
US

IV. Provider business mailing address

PO BOX 1000 DEPT 978
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-837-7979
  • Fax: 901-837-7999
Mailing address:
  • Phone: 901-837-7979
  • Fax: 901-837-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD31815
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: