MEDICARE: DR. RANDY J. BUCKSPAN 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
1	208200000X	Plastic Surgery Physician	90826	GA

General Provider Information

NPI Number	:	1336133495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY J. BUCKSPAN M.D.

Provider Business Mailing Address
First Line	:	9115 KATE CT
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-3960
Country	:	US
Telephone Number	:	512-924-8126
Fax Number	:

Provider Business Practice Location Address
First Line	:	9115 KATE CT
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-3960
Country	:	US
Telephone Number	:	512-924-8126
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	01/11/2022

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