Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | TP595 | KY |
N | 207Q00000X | Family Doctor | 0116024155 | VA |
NPI | 1013273853 |
---|---|
Provider Name | Andrew D Buckley |
First Address | Lexington, KY 40514-1325 |
Second Address | Lexington, KY 40514-1325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2012 |
Last Update Date | 07/08/2015 |