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General NPI Number Information
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NPI Number | 1003813478
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Entity Type | Individual
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Provider Name | KEVIN RAY BUCKWALTER MD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 7151 CASCADE VALLEY CT STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89128-0498
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Country | US
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Telephone | 702-568-8450
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Fax | 702-568-8451
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Provider Business Mailing Address
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Address Line | 1280 MONUMENT BLVD # 1
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City | CONCORD
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State | CA
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Zip | 94520-4405
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Country | US
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Telephone | 916-733-6993
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Fax | 916-733-6989
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A63401
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A63401
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A63401
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 8476
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License Number State | NV
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