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General NPI Number Information
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NPI Number | 1437195377
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Entity Type | Individual
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Provider Name | KENT PAUL VANBUECKEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 96 15TH ST NW SUITE 111
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City | NORTON
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State | VA
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Zip | 24273-1620
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Country | US
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Telephone | 276-439-1463
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Fax | 276-439-1464
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Provider Business Mailing Address
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Address Line | PO BOX 5127
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City | JOHNSON CITY
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State | TN
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Zip | 37602-5127
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Country | US
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Telephone | 423-952-2122
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Fax | 423-952-2145
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD00026111
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | MD0002611
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101255623
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License Number State | VA
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