Provider Demographics
NPI:1336507854
Name:VALENTINE, BUDDY I
Entity Type:Individual
Prefix:
First Name:BUDDY
Middle Name:
Last Name:VALENTINE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 BELFRY HWY
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9524
Mailing Address - Country:US
Mailing Address - Phone:307-586-3725
Mailing Address - Fax:
Practice Address - Street 1:137 BELFRY HWY
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9524
Practice Address - Country:US
Practice Address - Phone:307-586-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator