Basic Information
| Provider Information | |||||||||
| NPI: | 1174633069 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUXBAUM | ||||||||
| FirstName: | EVAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 24TH ST | ||||||||
| Address2: | |||||||||
| City: | ANACORTES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982212562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602933101 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7 DEYE LN | ||||||||
| Address2: | |||||||||
| City: | EASTSOUND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982458578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602933101 | ||||||||
| FaxNumber: | 3604666139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD15949 | HI | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | A116531 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 5472 | AK | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD60027949 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 8522369 | 05 | WA | MEDICAID | MD3127 | 05 | AK | MEDICAID |