Provider Demographics
NPI:1114197803
Name:JOHN L. BUKER, M.D., PSC
Entity Type:Organization
Organization Name:JOHN L. BUKER, M.D., PSC
Other - Org Name:BLUEGRASS DERMATOLOGY AND SKIN SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LANDON
Authorized Official - Last Name:BUKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-296-4400
Mailing Address - Street 1:3475 RICHMOND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2500
Mailing Address - Country:US
Mailing Address - Phone:859-296-4400
Mailing Address - Fax:859-296-4300
Practice Address - Street 1:3475 RICHMOND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2500
Practice Address - Country:US
Practice Address - Phone:859-296-4400
Practice Address - Fax:859-296-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7994Medicare PIN