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General NPI Number Information
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NPI Number | 1144422247
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Entity Type | Organization
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Legal Business Name | F GRANT BUCKLE MD A PROFESSIONAL CORP
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 1245 WILSHIRE BLVD STE 511
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City | LOS ANGELES
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State | CA
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Zip | 90017-4805
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Country | US
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Telephone | 213-977-1246
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Fax |
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Provider Business Mailing Address
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Address Line | 1245 WILSHIRE BLVD SUITE 511
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City | LOS ANGELES
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State | CA
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Zip | 90017-4810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FRANK GRANT BUCKLE
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Credential | M.D.
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Telephone | 213-977-1246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A24871
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License Number State | CA
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