Provider Demographics
NPI:1609151380
Name:BUFFINGTON, TARA SHEA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:SHEA
Last Name:BUFFINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 CUBA AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5646
Mailing Address - Country:US
Mailing Address - Phone:575-489-4616
Mailing Address - Fax:
Practice Address - Street 1:1909 CUBA AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310
Practice Address - Country:US
Practice Address - Phone:575-489-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program