Provider Demographics
NPI:1215040001
Name:BUCKLEY, MICHAEL A (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 490
Mailing Address - Street 2:PO BOX 9006
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96538-0490
Mailing Address - Country:US
Mailing Address - Phone:671-344-9419
Mailing Address - Fax:
Practice Address - Street 1:PSC 490
Practice Address - Street 2:ANESTHESIOLOGY
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96538-0490
Practice Address - Country:US
Practice Address - Phone:671-344-9419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8513207P00000X, 2083A0100X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX85130Medicaid
CA00AX85130Medicaid
CAI24946Medicare UPIN