Provider Demographics
NPI:1922482660
Name:ERIC C. BUXTON MD, INC.
Entity Type:Organization
Organization Name:ERIC C. BUXTON MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:BUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-464-8677
Mailing Address - Street 1:599 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1712
Mailing Address - Country:US
Mailing Address - Phone:415-464-8677
Mailing Address - Fax:415-464-8718
Practice Address - Street 1:599 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1712
Practice Address - Country:US
Practice Address - Phone:415-464-8677
Practice Address - Fax:415-464-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78113207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A781131Medicare PIN