Provider Demographics
NPI:1558302380
Name:BUFORD, GREGORY A (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:BUFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10459 PARK MEADOWS DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:303-951-5829
Mailing Address - Fax:303-951-0578
Practice Address - Street 1:10459 PARK MEADOWS DR
Practice Address - Street 2:STE 100
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-951-5829
Practice Address - Fax:303-951-0578
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39288174400000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42775833Medicaid
CO442338Medicare ID - Type Unspecified
CO42775833Medicaid