Provider Demographics
NPI:1922206168
Name:BUFORD, KEVIN-STEVEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN-STEVEN
Middle Name:C
Last Name:BUFORD
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 1:1816 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2314
Mailing Address - Country:US
Mailing Address - Phone:504-366-7638
Mailing Address - Fax:
Practice Address - Street 1:2000 CANAL STREET
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1352
Practice Address - Country:US
Practice Address - Phone:504-903-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD204496207PE0005X
PAMD438968207PE0005X
CAA100796207PE0005X
FL207PE0005X207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2155733Medicaid
PA187907E64Medicare PIN