Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0426254 | KS |
NPI | 1063410488 |
---|---|
Provider Name | Dr. Matthew G Buxton |
First Address | Lawrence, KS 66047-2196 |
Second Address | Lawrence, KS 66047-2196 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F93768 | (02) |