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1669413126

NPI Code Detail

MEDICARE: DR. TAMARA L WILLIS-BUCKLEY MD

MEDICARE: DR. TAMARA L WILLIS-BUCKLEY MD

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	207V00000X	Obstetrics & Gynecology Physician	MD-13841	HI
2	207V00000X	Obstetrics & Gynecology Physician	44373	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	018888	OTHER	CO	KAISER COMMERCIAL NUMBER
2	0000260901	OTHER	HI	HMSA BILLING NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669413126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMARA L WILLIS-BUCKLEY MD

Provider Business Mailing Address
First Line	:	2700 PHEASANT RUN
Second Line	:
City	:	BERTHOUD
State	:	CO
Zip	:	80513-8473
Country	:	US
Telephone Number	:	970-581-0119
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 W 72ND AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80221-2721
Country	:	US
Telephone Number	:	303-650-4460
Fax Number	:

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/12/2016

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Directions to “ DR. TAMARA L WILLIS-BUCKLEY MD” Practice Location

Language	Start Address	Practice Location

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