Provider Demographics
NPI:1649311390
Name:BUXTON, ROBERT E JR
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:BUXTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:REB
Other - Middle Name:
Other - Last Name:BUXTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:810 DOMINICAN DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1906
Mailing Address - Country:US
Mailing Address - Phone:615-283-0880
Mailing Address - Fax:
Practice Address - Street 1:810 DOMINICAN DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1906
Practice Address - Country:US
Practice Address - Phone:615-330-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TN2712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376955Medicare ID - Type UnspecifiedGROUP NUMBER