Provider Demographics
NPI:1912961905
Name:BERRY, BUFORD EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:BUFORD
Middle Name:EUGENE
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 E LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2151
Mailing Address - Country:US
Mailing Address - Phone:225-387-2707
Mailing Address - Fax:225-387-2718
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 1008
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-766-0416
Practice Address - Fax:225-769-9212
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02607R208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019705Medicaid
LA1130907Medicaid
MS00019705Medicaid
LA1130907Medicaid