Provider Demographics
NPI:1447215264
Name:BUFFINGTON, BILLY JOE (MD)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:JOE
Last Name:BUFFINGTON
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 1:1714 S KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3624
Mailing Address - Country:US
Mailing Address - Phone:405-216-3993
Mailing Address - Fax:405-216-3992
Practice Address - Street 1:1714 S KELLY AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3624
Practice Address - Country:US
Practice Address - Phone:405-216-3993
Practice Address - Fax:405-216-3992
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15483207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100101440AMedicaid
OKP00021467OtherRR MEDICARE
OKP00021467OtherRR MEDICARE
OKD38667Medicare UPIN