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General NPI Number Information
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NPI Number | 1598788507
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Entity Type | Individual
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Provider Name | VICTORIA RUTH BUCKNER DO
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2115 LEITER RD SYCAMORE PRIMARY CARE GROUP
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City | MIAMISBURG
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State | OH
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Zip | 45342-3659
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Country | US
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Telephone | 937-384-6800
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Fax | 937-384-6939
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Provider Business Mailing Address
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Address Line | 6661 CLYO RD
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City | CENTERVILLE
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State | OH
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Zip | 45459-2702
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Country | US
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Telephone | 937-425-4000
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Fax | 937-425-4002
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2006-01029
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34009103
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License Number State | OH
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