MEDICARE: DR. JOHN ALEXANDER BUXTON PH.D.11/07/1929

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	103TC0700X	Clinical Psychologist	20130054A	IN

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
2	I016328	OTHER	IN	CHAMPUS

General Provider Information

NPI Number	:	1306818786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ALEXANDER BUXTON PH.D.11/07/1929

Provider Business Mailing Address
First Line	:	301 N ROYAL AVE
Second Line	:	SUITE B
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-2866
Country	:	US
Telephone Number	:	812-474-1122
Fax Number	:	812-477-3842

Provider Business Practice Location Address
First Line	:	5035 CHARLOTTE AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47720-1466
Country	:	US
Telephone Number	:	812-474-1122
Fax Number	:	812-477-3669

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	10/03/2019

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