Provider Demographics
NPI:1053517060
Name:BUFORD, DAVID EDWARD (DPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EDWARD
Last Name:BUFORD
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 BLACKMON ST
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-6853
Mailing Address - Country:US
Mailing Address - Phone:731-783-1546
Mailing Address - Fax:
Practice Address - Street 1:6066 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3131
Practice Address - Country:US
Practice Address - Phone:731-686-1557
Practice Address - Fax:731-686-7645
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist