Doctor Name: | DR. CHARLES VANCE BUCKMASTER |
NPI Number: | 1194711382 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 00020768 |
Business Practice Address: | 8158 State Highway 59 Suite 107 Foley, AL - 365353880 |
Business Phone Number: | 2519551600 |
Business Fax Number: | 2519551602 |
Mailing Address: | 8158 State Hwy 59, Suite 107, FOLEY |
State: | AL |
Postal Code: | 36535 |
Phone Number: | 2519551600 |
Fax Number: | 2519437749 |
NPI Enumeration Date: | 09/22/2005 |
NPI Last Update Date: | 06/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 00020768 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |