Provider Demographics
NPI:1558355586
Name:BUIE, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:BUIE
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:PO BOX 2169
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-2169
Mailing Address - Country:US
Mailing Address - Phone:580-821-1185
Mailing Address - Fax:580-303-9166
Practice Address - Street 1:213 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5437
Practice Address - Country:US
Practice Address - Phone:580-774-5089
Practice Address - Fax:580-303-9166
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2023-10-19
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
OK18370208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS106938OtherBLUE CROSS
KS200538650AMedicaid
KS200538650AMedicaid
KS106938OtherBLUE CROSS
KSKA1011001Medicare PIN