Healthcare Provider Details

I. General information

NPI: 1003853664
Provider Name (Legal Business Name): MADISON H BUCKLEY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HUMPHREYS CTR SUITE 23
MEMPHIS TN
38120-2369
US

IV. Provider business mailing address

P.O. BOX 1000 DEPT 34
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-226-0810
  • Fax: 901-383-8985
Mailing address:
  • Phone: 901-383-8860
  • Fax: 901-383-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD004532
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: