Provider Demographics
NPI:1942360052
Name:BUFORD, JOE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:LEE
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 1:410 W PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-2146
Mailing Address - Country:US
Mailing Address - Phone:501-771-0674
Mailing Address - Fax:501-753-4147
Practice Address - Street 1:410 W PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2146
Practice Address - Country:US
Practice Address - Phone:501-771-0674
Practice Address - Fax:501-753-4147
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5376261QP2300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57813OtherPTAN
AR57813Medicare ID - Type Unspecified
AR57813OtherPTAN