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General NPI Number Information
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NPI Number | 1629893177
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Entity Type | Individual
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Provider Name | ZACHARY D BUCKLAND FNP-C
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Gender | Male
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 2001 S WOODRUFF AVE STE 15B
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6372
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Country | US
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Telephone | 208-357-4633
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Fax |
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Provider Business Mailing Address
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Address Line | 4137 E 132 N
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City | RIGBY
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State | ID
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Zip | 83442-5813
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Country | US
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Telephone | 208-570-7944
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Fax |
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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 | 6671238
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License Number State | ID
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