Provider Demographics
NPI:1447359922
Name:RYAN P BUFFALO
Entity type:Organization
Organization Name:RYAN P BUFFALO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUFFALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-352-5800
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-1148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:501-362-5818
Practice Address - Street 1:2725 HIGHWAY 25 B NORTH
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543
Practice Address - Country:US
Practice Address - Phone:501-352-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145515002Medicaid
AR145515002Medicaid