Provider Demographics
NPI:1306818786
Name:BUXTON, JOHN ALEXANDER (PHD11/07/1929)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:BUXTON
Suffix:
Gender:M
Credentials:PHD11/07/1929
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Other - First Name:
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Mailing Address - Street 1:301 N ROYAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2866
Mailing Address - Country:US
Mailing Address - Phone:812-474-1122
Mailing Address - Fax:812-477-3842
Practice Address - Street 1:5035 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47720-1466
Practice Address - Country:US
Practice Address - Phone:812-474-1122
Practice Address - Fax:812-477-3669
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN20130054A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100241910AMedicaid
INI016328OtherCHAMPUS
INR34342Medicare UPIN