Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 1976 | SD |
NPI | 1023545423 |
---|---|
Provider Name | Jacy Rae Buffington |
First Address | Buffalo, SD 57720-6002 |
Second Address | Buffalo, SD 57720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2017 |
Last Update Date | 03/10/2019 |