Provider Demographics
NPI:1184052581
Name:BUFFA, JAMES (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BUFFA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 E BENNINGTON RD
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-8739
Mailing Address - Country:US
Mailing Address - Phone:989-413-3805
Mailing Address - Fax:
Practice Address - Street 1:1241 E DYER RD
Practice Address - Street 2:SUITE 145
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5611
Practice Address - Country:US
Practice Address - Phone:949-289-9754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant