Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | ME68241 | FL |
NPI | 1396794681 |
---|---|
Provider Name | Dr. Stephen Leslie Buckley |
First Address | Jacksonville, FL 32232-5278 |
Second Address | Jacksonville, FL 32207-8432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2006 |
Last Update Date | 12/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
146316572D | (05) | GA |
258772600 | (05) | FL |
P01265837 | RR MEDICARE (01) | FL |