Provider Demographics
NPI:1649277450
Name:BUFTON, LINDA L (MD)
Entity type:Individual
Prefix:MISS
First Name:LINDA
Middle Name:L
Last Name:BUFTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4553
Practice Address - Street 1:1900 WOODLAND DRIVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-0000
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4553
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR165342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1407812365OtherMEDICARE GROUP NPI
OR011754Medicaid
ORR0000WFBTVOtherMEDICARE GROUP PIN
OR930635514OtherTAX ID
ORR0000WFBTVOtherMEDICARE GROUP PIN
ORE46695Medicare UPIN
OR011754Medicaid
ORR142977Medicare PIN