Provider Demographics
NPI:1043229248
Name:BUCKLEY, PAT A (ND, PA-C)
Entity Type:Individual
Prefix:DR
First Name:PAT
Middle Name:A
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:ND, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 WEST BURNSIDE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3514
Mailing Address - Country:US
Mailing Address - Phone:503-228-4533
Mailing Address - Fax:503-228-7135
Practice Address - Street 1:727 WEST BURNSIDE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3514
Practice Address - Country:US
Practice Address - Phone:503-228-4533
Practice Address - Fax:503-228-4618
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001395175F00000X
OR1248R175F00000X
ORPA150263363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No175F00000XOther Service ProvidersNaturopath