Healthcare Provider Details

I. General information

NPI: 1558391037
Provider Name (Legal Business Name): ROBERT ALAN BUCKLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE RM 7M
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

PO BOX 7464
SAN FRANCISCO CA
94120-7464
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-5612
  • Fax: 415-206-8942
Mailing address:
  • Phone: 415-206-3103
  • Fax: 415-206-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA36204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: