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General NPI Number Information
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NPI Number | 1942407283
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Entity Type | Organization
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Legal Business Name | PARK AVENUE WALK IN CLINIC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 1280 MONUMENT BLVD STE 1
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City | CONCORD
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State | CA
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Zip | 94520-4405
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Country | US
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Telephone | 925-825-8181
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Fax | 925-825-8383
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Provider Business Mailing Address
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Address Line | 1280 MONUMENT BLVD STE 1
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City | CONCORD
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State | CA
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Zip | 94520-4405
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Country | US
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Telephone | 925-825-8181
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Fax | 925-825-8383
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. KEVIN BUCKWALTER
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Credential | MD
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Telephone | 925-825-8181
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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 | A63401
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License Number State | CA
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