MEDICARE: DR. STEPHEN LESLIE 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	207VX0201X	Gynecologic Oncology Physician	ME68241	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01265837	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396794681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN LESLIE BUCKLEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 45278
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32232-5278
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	904-393-7603

Provider Business Practice Location Address
First Line	:	1301 PALM AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8432
Country	:	US
Telephone Number	:	904-202-7300
Fax Number	:	904-202-7433

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	12/12/2019

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Directions to “ DR. STEPHEN LESLIE BUCKLEY M.D.” Practice Location

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