Provider Demographics
NPI:1740264050
Name:MIKE BUFFINGTON, M.D., P.A.
Entity type:Organization
Organization Name:MIKE BUFFINGTON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUFFINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-289-5865
Mailing Address - Street 1:PO BOX 1266
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1266
Mailing Address - Country:US
Mailing Address - Phone:479-521-1420
Mailing Address - Fax:
Practice Address - Street 1:34 W COLT SQUARE DR STE 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2888
Practice Address - Country:US
Practice Address - Phone:479-521-1420
Practice Address - Fax:866-286-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F384OtherBCBS
AR5F384Medicare PIN