Healthcare Provider Details

I. General information

NPI: 1043229248
Provider Name (Legal Business Name): PAT A BUCKLEY ND, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 WEST BURNSIDE
PORTLAND OR
97209-3514
US

IV. Provider business mailing address

727 WEST BURNSIDE
PORTLAND OR
97209-3514
US

V. Phone/Fax

Practice location:
  • Phone: 503-228-4533
  • Fax: 503-228-4618
Mailing address:
  • Phone: 503-228-4533
  • Fax: 503-228-7135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00001395
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1248R
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA150263
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: