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1396752879

NPI Code Detail

MEDICARE: MARK BRIAN BUCKNER M.D.

MEDICARE: MARK BRIAN BUCKNER 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	207P00000X	Emergency Medicine Physician	J1898	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8W0344	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	8W0739	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1396752879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK BRIAN BUCKNER M.D.

Provider Business Mailing Address
First Line	:	332 KLAS RD
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75092-5959
Country	:	US
Telephone Number	:	903-813-0521
Fax Number	:

Provider Business Practice Location Address
First Line	:	913 COTTONWOOD DR
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-2831
Country	:	US
Telephone Number	:	903-868-9565
Fax Number	:	903-893-8916

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	03/06/2012

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Directions to “ MARK BRIAN BUCKNER M.D.” Practice Location

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