Healthcare Provider Details

I. General information

NPI: 1922494582
Provider Name (Legal Business Name): JON CHRISTOPHER BUCKLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 TULANE AVENUE, #TB53
NEW ORLEANS LA
70112-2715
US

IV. Provider business mailing address

1440 TULANE AVENUE, #TB53
NEW ORLEANS LA
70112-2715
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-4272
  • Fax: 504-988-4270
Mailing address:
  • Phone: 504-988-4272
  • Fax: 504-988-4270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: