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NPI Code Detail

MEDICARE: MARK BUCKNER MD PA

MEDICARE: MARK BUCKNER MD 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
1261QE0002XEmergency Care Clinic/CenterJ1898TX

General Provider Information

NPI Number : 1497038913
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARK BUCKNER MD PA
Provider Business Mailing 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
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 : PRESIDENT
Name : MARK BRIAN BUCKNER
Credential : M.D.
Telephone Number : 903-868-9565
Provider Enumeration Date : 09/21/2011
Last Update Date : 09/21/2011

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