Healthcare Provider Details

I. General information

NPI: 1497404933
Provider Name (Legal Business Name): BRANDEN BUFFINGTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 E KIMBALLS LN STE 260
DRAPER UT
84020-5009
US

IV. Provider business mailing address

74 E KIMBALLS LN STE 260
DRAPER UT
84020-5009
US

V. Phone/Fax

Practice location:
  • Phone: 801-895-3146
  • Fax: 801-850-6611
Mailing address:
  • Phone: 801-895-3146
  • Fax: 801-850-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13505049-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: