Provider Demographics
NPI:1225131139
Name:BUCKLES, DANIEL C (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:BUCKLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD, RM 4035
Mailing Address - Street 2:WESCOE MAILSTOP 1023
Mailing Address - City:KANSAS CITY,
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6003
Mailing Address - Fax:913-588-3975
Practice Address - Street 1:3901 RAINBOW BLVD, RM 4035
Practice Address - Street 2:WESCOE MAILSTOP 1023
Practice Address - City:KANSAS CITY,
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29552207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200316250AMedicaid
KS927245OtherFIRSTGUARD
MO207329400Medicaid
MO35362011OtherBCBS KC
KSP00245325Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KS200316250AMedicaid
KS927245OtherFIRSTGUARD