Provider Demographics
NPI:1215177985
Name:JOE LEE BUFORD MD PA
Entity Type:Organization
Organization Name:JOE LEE BUFORD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-771-0674
Mailing Address - Street 1:410 W PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-2146
Mailing Address - Country:US
Mailing Address - Phone:501-771-0674
Mailing Address - Fax:501-753-4174
Practice Address - Street 1:410 W PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2146
Practice Address - Country:US
Practice Address - Phone:501-771-0674
Practice Address - Fax:501-753-4174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARB90020Medicare UPIN
AR57813Medicare PIN