Provider Demographics
NPI:1326075391
Name:BUFFALOE, ROBERT NEAL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:NEAL
Last Name:BUFFALOE
Suffix:
Gender:M
Credentials:MD
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 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:308 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248
Practice Address - Country:US
Practice Address - Phone:660-248-2217
Practice Address - Fax:660-248-3450
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120036972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ796071Medicaid
NM24228214Medicaid
TX8HBP45Medicare ID - Type UnspecifiedHSZ006
TX8HBQ66Medicare ID - Type UnspecifiedHSZ001
TX8HBX43Medicare ID - Type UnspecifiedHSZ197
TX8HBQ67Medicare ID - Type UnspecifiedHSZ002
A14067Medicare UPIN
TX8HBQ68Medicare ID - Type UnspecifiedHSZ003
AZ796071Medicaid
NM24228214Medicaid