Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 44363 | MA |
Y | 208600000X | Surgeon | 44363 | MA |
NPI | 1013905025 |
---|---|
Provider Name | Dr. Frederick Oliver Buckley JR. |
First Address | Danvers, MA 01923-3623 |
Second Address | Danvers, MA 01923-3623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 18/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2071843 | (05) | MA |
D08909 | (02) | MA |