Healthcare Provider Details

I. General information

NPI: 1063594778
Provider Name (Legal Business Name): ROBERT KENDALL BUCKENBERGER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1642 E HERNDON AVE SUITE 103
FRESNO CA
93720-3377
US

IV. Provider business mailing address

1642 E HERNDON AVE SUITE 103
FRESNO CA
93720-3377
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-8642
  • Fax: 559-433-9834
Mailing address:
  • Phone: 559-439-8642
  • Fax: 559-433-9834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: