Doctor Name: | IRENE BUCKNER |
NPI Number: | 1003836669 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 16074 |
Business Practice Address: | 785 Ohio Ave Ste 2b Clarksdale, MS - 386146216 |
Business Phone Number: | 6626245481 |
Business Fax Number: | |
Mailing Address: | 785 Ohio Ave Ste 2b, CLARKSDALE |
State: | MS |
Postal Code: | 386146216 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/19/2006 |
NPI Last Update Date: | 08/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 16074 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |