Provider Demographics
NPI:1013991124
Name:BUXA, GARY A (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:BUXA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 PLACER ST
Mailing Address - Street 2:STE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2364
Mailing Address - Country:US
Mailing Address - Phone:530-243-3687
Mailing Address - Fax:530-243-3383
Practice Address - Street 1:3305 PLACER ST
Practice Address - Street 2:STE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2364
Practice Address - Country:US
Practice Address - Phone:530-243-3687
Practice Address - Fax:530-243-3383
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA74853207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00114242OtherRAILROAD MEDICARE
CA00A748530Medicaid
CAH47863Medicare UPIN
CA00A748530Medicaid