Provider Demographics
NPI:1124203617
Name:BUCKELEW, BEVERLY S (RT (R)(M)(CT))
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:S
Last Name:BUCKELEW
Suffix:
Gender:F
Credentials:RT (R)(M)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 WOLF RUN
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-9366
Mailing Address - Country:US
Mailing Address - Phone:573-714-3650
Mailing Address - Fax:
Practice Address - Street 1:3015 WOLF RUN
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-9366
Practice Address - Country:US
Practice Address - Phone:573-714-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography