Provider Demographics
NPI:1598235210
Name:BUFORD, HASKEL JOHN (MPH, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:HASKEL
Middle Name:JOHN
Last Name:BUFORD
Suffix:
Gender:M
Credentials:MPH, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 SPRING MEADOW XING
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3442
Mailing Address - Country:US
Mailing Address - Phone:636-614-5854
Mailing Address - Fax:
Practice Address - Street 1:14532 S OUTER 40 RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5705
Practice Address - Country:US
Practice Address - Phone:636-614-5854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer