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General NPI Number Information
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NPI Number | 1649264847
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Entity Type | Individual
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Provider Name | CARL WILLIAM BUCKHORN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/02/2005
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Last Update Date | 07/14/2009
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Provider Practice Location Address
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Address Line | 18300 YORBA LINDA BLVD STE 204
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City | YORBA LINDA
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State | CA
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Zip | 92886-4052
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Country | US
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Telephone | 714-577-6031
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Fax | 714-572-2562
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Provider Business Mailing Address
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Address Line | 18200 YORBA LINDA BLVD STE 401
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City | YORBA LINDA
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State | CA
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Zip | 92886-4056
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Country | US
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Telephone | 714-646-8000
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Fax | 714-572-2562
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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 | G73630
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License Number State | CA
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