Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MED-PHYS-LIC-36012 | MT |
Y | 207XS0106X | Orthopaedic Hand Surgeon | MED-PHYS-LIC-36012 | MT |
NPI | 1063654283 |
---|---|
Provider Name | Taylor Buckley |
First Address | Missoula, MT 59804-5137 |
Second Address | Missoula, MT 59804-5137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2009 |
Last Update Date | 20/05/2019 |