Provider Demographics
NPI:1356330666
Name:BUFFALO, RYAN P (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:P
Last Name:BUFFALO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-812-7800
Mailing Address - Fax:501-812-7777
Practice Address - Street 1:20 BAPTIST HEALTH DR
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-8765
Practice Address - Country:US
Practice Address - Phone:501-362-0500
Practice Address - Fax:501-362-0501
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2018-05-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE2284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR138939001Medicaid
AR138939001Medicaid
ARH00410Medicare UPIN