MEDICARE: BUFFY J COOK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD31815	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063406114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BUFFY J COOK MD

Provider Business Mailing Address
First Line	:	PO BOX 1000
Second Line	:	DEPT 978
City	:	MEMPHIS
State	:	TN
Zip	:	38148-0001
Country	:	US
Telephone Number	:	901-837-7979
Fax Number	:	901-837-7999

Provider Business Practice Location Address
First Line	:	1880 OLD HWY 51 SUITE C
Second Line	:
City	:	BRIGHTON
State	:	TN
Zip	:	38011-7043
Country	:	US
Telephone Number	:	901-837-7979
Fax Number	:	901-837-7999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	12/01/2016

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Directions to “ BUFFY J COOK MD” Practice Location

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