MEDICARE: BUFFINTON B BURTIS 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	207RP1001X	Pulmonary Disease Physician	1149	AK

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	290004206	OTHER		RAILROAD

General Provider Information

NPI Number	:	1831168301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BUFFINTON B BURTIS MD

Provider Business Mailing Address
First Line	:	PO BOX 1047
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73648-1047
Country	:	US
Telephone Number	:	580-225-8600
Fax Number	:	580-225-8603

Provider Business Practice Location Address
First Line	:	1710 W 3RD ST
Second Line	:	SUITE 103B
City	:	ELK CITY
State	:	OK
Zip	:	73644-5159
Country	:	US
Telephone Number	:	580-225-8600
Fax Number	:	580-225-8603

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	01/13/2010

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Directions to “ BUFFINTON B BURTIS MD” Practice Location

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