Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | G21130 | CA |
NPI | 1952528028 |
---|---|
Provider Name | Dr. Walter S Buckley III |
First Address | Westlake Village, CA 91361-2504 |
Second Address | Downey, CA 90240-4014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A41192 | (02) | CA |