Provider Demographics
NPI:1285616045
Name:BUFKIN, WILLIAM J (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:BUFKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:124 W PITKIN AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2021
Mailing Address - Country:US
Mailing Address - Phone:719-584-7410
Mailing Address - Fax:719-542-7019
Practice Address - Street 1:124 W PITKIN AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2021
Practice Address - Country:US
Practice Address - Phone:719-584-7410
Practice Address - Fax:719-542-7019
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO183112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO44272758Medicaid
E14245Medicare UPIN
C508998Medicare ID - Type Unspecified