Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | BB2667585 | NY |
NPI | 1174618334 |
---|---|
Provider Name | Dr. Robert Sean Buckley |
First Address | Depew, NY 14043-4450 |
Second Address | Williamsville, NY 14221-7380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01264731 | (05) | NY |
F03547 | (02) | NY |