MEDICARE: DUSTAN PIERCE BUCKLEY MD

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	207R00000X	Internal Medicine Physician	18504	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110224377	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1730171794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTAN PIERCE BUCKLEY MD

Provider Business Mailing Address
First Line	:	9100 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-4417
Country	:	US
Telephone Number	:	405-840-4456
Fax Number	:	405-840-4295

Provider Business Practice Location Address
First Line	:	9100 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120
Country	:	US
Telephone Number	:	405-840-4456
Fax Number	:	405-840-4295

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	05/16/2018

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