Provider Demographics
NPI:1164422663
Name:BUFFEY, TIMOTHY J (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:BUFFEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FRANKLIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3592
Mailing Address - Country:US
Mailing Address - Phone:309-268-3761
Mailing Address - Fax:309-268-5620
Practice Address - Street 1:1100 E DIMOND BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2010
Practice Address - Country:US
Practice Address - Phone:907-333-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK145829207Q00000X
OH34007910207Q00000X
MI5101012318207Q00000X
IL036-121749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000245783OtherANTHEM
IL36121749Medicaid
OH04238OtherPARAMOUNT
OH2357926Medicaid
IL5715390OtherBLUE CROSS/ BLUE SHIELD
OH080191223OtherRRMC
OH17-29002OtherUHC
OH5993729OtherAETNA
OH000000245783OtherANTHEM
IL5715390OtherBLUE CROSS/ BLUE SHIELD
IL36121749Medicaid
ILK52830Medicare UPIN