MEDICARE: MR. JOSEPH BUCKNER EDDINS III PA

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	363A00000X	Physician Assistant	0110005877	VA

General Provider Information

NPI Number	:	1285611269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH BUCKNER EDDINS III PA

Provider Business Mailing Address
First Line	:	213 S JEFFERSON ST
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24011-1705
Country	:	US
Telephone Number	:	540-224-5374
Fax Number	:	540-224-5684

Provider Business Practice Location Address
First Line	:	4035 ELECTRIC RD STE A
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-8449
Country	:	US
Telephone Number	:	540-772-8670
Fax Number	:	540-772-7901

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	03/24/2021

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