Healthcare Provider Details

I. General information

NPI: 1023487824
Provider Name (Legal Business Name): MARK RANDALL BUCHERT JR. DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 OLD TORY TRL
AIKEN SC
29801-7636
US

IV. Provider business mailing address

1024 OLD TORY TRL
AIKEN SC
29801-7636
US

V. Phone/Fax

Practice location:
  • Phone: 504-214-4531
  • Fax:
Mailing address:
  • Phone: 504-214-4531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberLA3185
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: