Healthcare Provider Details

I. General information

NPI: 1114010014
Provider Name (Legal Business Name): DONALD LEROY BUCKLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10335 N SCOTTSDALE RD
SCOTTSDALE AZ
85253-1435
US

IV. Provider business mailing address

3412 E CALAVEROS DR
PHOENIX AZ
85028-4974
US

V. Phone/Fax

Practice location:
  • Phone: 480-991-9358
  • Fax: 480-483-3858
Mailing address:
  • Phone: 602-690-7243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number14628
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: