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General NPI Number Information
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NPI Number | 1700867074
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Entity Type | Individual
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Provider Name | RAPHAEL A BUCKLE MD
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Gender | Male
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Dates
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Enumeration Date | 11/14/2005
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Last Update Date | 03/02/2010
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Provider Practice Location Address
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Address Line | 900 EARL FRYE BLVD SUITE A
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City | AMORY
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State | MS
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Zip | 38821-5507
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Country | US
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Telephone | 662-256-9331
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Fax | 662-256-9335
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Provider Business Mailing Address
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Address Line | 900 EARL FRYE BLVD SUITE A
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City | AMORY
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State | MS
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Zip | 38821-5507
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Country | US
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Telephone | 662-256-9331
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Fax | 662-256-9336
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 56408
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 56408
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 20416
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License Number State | MS
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