Provider Demographics
NPI:1083690846
Name:BUCKLE, ROSEMARY (MD)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:BUCKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SHULT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-3016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 SHULT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-3015
Practice Address - Country:US
Practice Address - Phone:979-493-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7540207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115331402Medicaid
TX851735Medicare PIN