MEDICARE: ALICE BUCKLEY MD PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363AM0700X	Medical Physician Assistant
2	363L00000X	Nurse Practitioner
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1548410848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALICE BUCKLEY MD PC

Provider Business Mailing Address
First Line	:	1297 NEVADA HWY STE A
Second Line	:
City	:	BOULDER CITY
State	:	NV
Zip	:	89005-1854
Country	:	US
Telephone Number	:	702-294-1919
Fax Number	:	702-294-0072

Provider Business Practice Location Address
First Line	:	1297 NEVADA HWY STE A
Second Line	:
City	:	BOULDER CITY
State	:	NV
Zip	:	89005-1854
Country	:	US
Telephone Number	:	702-294-1919
Fax Number	:	702-294-0072

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALICE BUCKLEY
Credential	:	MD
Telephone Number	:	702-294-1919

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	09/23/2008

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