Healthcare Provider Details

I. General information

NPI: 1134185150
Provider Name (Legal Business Name): PETER J BUECKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4331 CHURCHMAN AVE SUITE 101
LOUISVILLE KY
40215-1164
US

IV. Provider business mailing address

4331 CHURCHMAN AVE SUITE 101
LOUISVILLE KY
40215-1164
US

V. Phone/Fax

Practice location:
  • Phone: 502-364-0902
  • Fax: 502-364-0099
Mailing address:
  • Phone: 502-364-0902
  • Fax: 502-364-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35801
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: