Provider Demographics
NPI:1831168301
Name:BURTIS, BUFFINTON B (MD)
Entity type:Individual
Prefix:
First Name:BUFFINTON
Middle Name:B
Last Name:BURTIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BUFF
Other - Middle Name:B
Other - Last Name:BURTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1047
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-1047
Mailing Address - Country:US
Mailing Address - Phone:580-225-8600
Mailing Address - Fax:580-225-8603
Practice Address - Street 1:1710 W 3RD ST
Practice Address - Street 2:SUITE 103B
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5159
Practice Address - Country:US
Practice Address - Phone:580-225-8600
Practice Address - Fax:580-225-8603
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1149207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1149Medicaid
290004206OtherRAILROAD
C98307Medicare UPIN
AK0000BHDJXMedicare ID - Type Unspecified
AKMD1149Medicaid