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NPI Code Detail

MEDICARE: ZACK THERRELL BUCKALEW III M.D.

MEDICARE: ZACK THERRELL BUCKALEW III M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician012656LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205829199
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZACK THERRELL BUCKALEW III M.D.
Provider Business Mailing Address
First Line : PO BOX 13030
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71315-3030
Country : US
Telephone Number : 318-445-9331
Fax Number : 318-619-6899
Provider Business Practice Location Address
First Line : 176 VERSAILLES BLVD
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71303-2493
Country : US
Telephone Number : 318-445-9331
Fax Number : 318-619-6899
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2005
Last Update Date : 09/28/2020

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