MEDICARE: DR. STEVEN MARK BUCKLES D.O.

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	207Q00000X	Family Medicine Physician	105609	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	P00245635	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2324148	OTHER	MO	AETNA
2	254381	OTHER	MO	HEALTHLINK
3	431898609	OTHER	MO	TRICARE
4	431898609	OTHER	MO	HEALTH CHOICE
5	10001146903	OTHER	MO	COMMUNITY HEALTH PLAN
6	21061107	OTHER	MO	BCBS OF KC
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922056480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN MARK BUCKLES D.O.

Provider Business Mailing Address
First Line	:	3404 WATERFORD CT
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-4552
Country	:	US
Telephone Number	:	816-279-8431
Fax Number	:	816-279-4008

Provider Business Practice Location Address
First Line	:	3949 SHERMAN AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3649
Country	:	US
Telephone Number	:	816-279-4882
Fax Number	:	816-279-4008

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	02/22/2008

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