Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A74853 | CA |
NPI | 1013991124 |
---|---|
Provider Name | Gary A Buxa |
First Address | Redding, CA 96001-2364 |
Second Address | Redding, CA 96001-2364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 05/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A748530 | (05) | CA |
H47863 | (02) | CA |
P00114242 | RAILROAD MEDICARE (01) | GA |