Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | K5468 | TX |
NPI | 1467434142 |
---|---|
Provider Name | Edward D Buckingham |
First Address | Austin, TX 78767-0128 |
Second Address | Austin, TX 78746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 06/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
144634100 | FIRST CARE (01) | |
163600302 | (05) | TX |
276816 | AMERIGROUP (01) | |
8V2550 | BCBS (01) | TX |
H71396 | (02) |