Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 11124 | NC |
NPI | 1619042736 |
---|---|
Provider Name | Rebecca H. Buckley |
First Address | Durham, NC 27704-2121 |
Second Address | Durham, NC 27704-2121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 18/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19470 | BCBS (01) | NC |
8919470 | (05) | NC |
AB5044982 | DEA (01) |