MEDICARE: TAYLOR BUCKLEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	MED-PHYS-LIC-36012	MT
2	207XS0106X	Orthopaedic Hand Surgery Physician	MED-PHYS-LIC-36012	MT

General Provider Information

NPI Number	:	1063654283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR BUCKLEY M.D.

Provider Business Mailing Address
First Line	:	2740 SOUTH AVE W STE 101
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-5137
Country	:	US
Telephone Number	:	406-728-6101
Fax Number	:	406-721-3278

Provider Business Practice Location Address
First Line	:	2740 SOUTH AVE W STE 101
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-5137
Country	:	US
Telephone Number	:	406-728-6101
Fax Number	:	406-721-3278

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2009
Last Update Date	:	05/20/2019

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