Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 210879 | NY |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 210879 | NY |
NPI | 1235121633 |
---|---|
Provider Name | Dr. Rudolph A Buckley |
First Address | Hamilton, NY 13346-1227 |
Second Address | Hamilton, NY 13346-1227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 24/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1174755003 | GROUP NPI (01) | |
G10002 | (02) |