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General NPI Number Information
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NPI Number | 1497038913
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Entity Type | Organization
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Legal Business Name | MARK BUCKNER MD PA
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 913 COTTONWOOD DR
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City | SHERMAN
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State | TX
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Zip | 75090-2831
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Country | US
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Telephone | 903-868-9565
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Fax | 903-893-8916
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Provider Business Mailing Address
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Address Line | 913 COTTONWOOD DR
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City | SHERMAN
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State | TX
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Zip | 75090-2831
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Country | US
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Telephone | 903-868-9565
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Fax | 903-893-8916
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK BRIAN BUCKNER
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Credential | M.D.
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Telephone | 903-868-9565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number | J1898
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License Number State | TX
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