Provider Demographics
NPI:1427378926
Name:PETER M BUFFA SR PA
Entity Type:Organization
Organization Name:PETER M BUFFA SR PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BUFFA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:254-739-5744
Mailing Address - Street 1:PO BOX 1516
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-1516
Mailing Address - Country:US
Mailing Address - Phone:254-739-5744
Mailing Address - Fax:254-739-5751
Practice Address - Street 1:600 S BONHAM ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-3603
Practice Address - Country:US
Practice Address - Phone:254-739-5744
Practice Address - Fax:254-739-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209668701Medicaid
TX209668701Medicaid