Provider Demographics
NPI:1932156189
Name:DAMRON, BUFFY (PA)
Entity Type:Individual
Prefix:MRS
First Name:BUFFY
Middle Name:
Last Name:DAMRON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:BUFFY
Other - Middle Name:
Other - Last Name:JACOBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2817 PARKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4210
Mailing Address - Country:US
Mailing Address - Phone:405-737-0203
Mailing Address - Fax:405-737-0221
Practice Address - Street 1:2817 PARKLAWN DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4210
Practice Address - Country:US
Practice Address - Phone:405-737-0203
Practice Address - Fax:405-737-0221
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1332363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243412603Medicare ID - Type Unspecified