Provider Demographics
NPI:1265441661
Name:BUCKLEY, LAURA R (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:202 SW 25TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-8299
Mailing Address - Country:US
Mailing Address - Phone:940-328-6521
Mailing Address - Fax:940-328-7501
Practice Address - Street 1:202 SW 25TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-8299
Practice Address - Country:US
Practice Address - Phone:940-328-6521
Practice Address - Fax:940-328-7501
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXS2247207Q00000X
CO43871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine