Provider Demographics
NPI:1073765087
Name:BUFFA, PETER MICHAEL SR (MD, PA)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:BUFFA
Suffix:SR
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1516
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-1516
Mailing Address - Country:US
Mailing Address - Phone:254-739-5744
Mailing Address - Fax:254-739-5751
Practice Address - Street 1:600 S BONHAM ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-3603
Practice Address - Country:US
Practice Address - Phone:254-739-5744
Practice Address - Fax:254-739-5751
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4315207P00000X, 207Q00000X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209668701Medicaid
TXB106605Medicare PIN