Healthcare Provider Details

I. General information

NPI: 1346241122
Provider Name (Legal Business Name): DAWN C BUCKINGHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 BURNET RD
AUSTIN TX
78756-2611
US

IV. Provider business mailing address

5011 BURNET RD
AUSTIN TX
78756-2611
US

V. Phone/Fax

Practice location:
  • Phone: 512-583-2020
  • Fax: 512-744-2020
Mailing address:
  • Phone: 512-583-2020
  • Fax: 512-744-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberK5467
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: