Healthcare Provider Details

I. General information

NPI: 1376562611
Provider Name (Legal Business Name): FRANKLIN CHARLES BUCKNER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4816 PINEVIEW WAY
ANTIOCH CA
94531
US

IV. Provider business mailing address

4816 PINEVIEW WAY
ANTIOCH CA
94531
US

V. Phone/Fax

Practice location:
  • Phone: 650-380-4862
  • Fax: 510-581-6679
Mailing address:
  • Phone: 650-380-4862
  • Fax: 510-581-6679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG18206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: