Basic Information
| Provider Information | |||||||||
| NPI: | 1821072299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUFKIN | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | LANCE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6006 49TH ST N | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275279779 | ||||||||
| FaxNumber: | 7275220415 | ||||||||
| Practice Location | |||||||||
| Address1: | 270 S MOON AVE | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135719988 | ||||||||
| FaxNumber: | 8135719922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | ME102775 | FL | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 000429900 | 05 | FL | MEDICAID |