Basic Information
| Provider Information | |||||||||
| NPI: | 1588650824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUFFY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 179 EAGLE DR N | ||||||||
| Address2: | |||||||||
| City: | CANON CITY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812129652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195302000 | ||||||||
| FaxNumber: | 7195302055 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 W HWY 50 | ||||||||
| Address2: | |||||||||
| City: | SALIDA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812012238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195302000 | ||||||||
| FaxNumber: | 7195302055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 17434 | CO | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 01174341 | 05 | CO | MEDICAID |