MEDICARE: WAYNE L BRUFFETT M.D.

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	207X00000X	Orthopaedic Surgery Physician	E-0263	AR
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	E-0263	AR

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	5K023C207	OTHER	AR	PTAN

General Provider Information

NPI Number	:	1952389280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE L BRUFFETT M.D.

Provider Business Mailing Address
First Line	:	4301 W MARKHAM ST # 783
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-7101
Country	:	US
Telephone Number	:	501-686-8000
Fax Number	:	501-526-5148

Provider Business Practice Location Address
First Line	:	4261 STOCKTON DR STE 100
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2916
Country	:	US
Telephone Number	:	501-526-7219
Fax Number	:	501-526-7201

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	07/31/2023

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