Individual
BUFORD HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
1401 HARRODSBURG ROAD, SUITE A-540, LEXINGTON, KY 40504
(859) 258-6760
(859) 258-6512
Mailing address
1401 HARRODSBURG ROAD, SUITE A-540, LEXINGTON, KY 40504
(859) 258-6760
(859) 258-6512
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
PA218
KY
363A00000X
Physician Assistant
Primary
PA218
KY
363AM0700X
Medical Physician Assistant
PA218
KY
363AS0400X
Surgical Physician Assistant
PA218
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36000818
ASC MEDICAID GROUP
KY
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE GROUP LAB
KY
05
—
95002184
—
KY
01
—
970008315
RR MEDICARE PIN NO
KY
01
—
ASC1019
ASC MEDICARE GROUP
KY
01
—
CB5773
MEDICARE RR GROUP
KY
Enumeration date
10/03/2006
Last updated
12/09/2020
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