Provider Demographics
NPI:1073327482
Name:BUFFINGTON, KEEGAN JAMES
Entity type:Individual
Prefix:
First Name:KEEGAN
Middle Name:JAMES
Last Name:BUFFINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 E 2ND AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2589
Mailing Address - Country:US
Mailing Address - Phone:952-412-9433
Mailing Address - Fax:
Practice Address - Street 1:279 E 2ND AVE APT 1
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2589
Practice Address - Country:US
Practice Address - Phone:952-412-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program