Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 792 | FL |
NPI | 1194850388 |
---|---|
Provider Name | Dr. John Buckner |
First Address | Gainesville, FL 32605 |
Second Address | Gainesville, FL 32605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 11/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
084305900 | (05) | FL |
421588508 | TAX ID (01) | FL |
796 | FLORDIA LIC NUMBER (01) | FL |
T83919 | (02) | FL |