MEDICARE: JOHN BUCKNER 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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1770393654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BUCKNER PA

Provider Business Mailing Address
First Line	:	2409 SPRING ST
Second Line	:
City	:	COLUMBUS CITY
State	:	IA
Zip	:	52737-9302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2409 SPRING ST
Second Line	:
City	:	COLUMBUS CITY
State	:	IA
Zip	:	52737-9302
Country	:	US
Telephone Number	:	319-728-7400
Fax Number	:

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

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/30/2025

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