Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 0 | MO |
NPI | 1174173066 |
---|---|
Provider Name | Timothy Austin Buxman |
First Address | Bridgeton, MO 63044-2901 |
Second Address | Saint Louis, MO 63141-8221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2019 |
Last Update Date | 10/08/2020 |