Provider Demographics
NPI:1376562611
Name:BUCKNER, FRANKLIN CHARLES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:CHARLES
Last Name:BUCKNER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4816 PINEVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531
Mailing Address - Country:US
Mailing Address - Phone:650-380-4862
Mailing Address - Fax:510-581-6679
Practice Address - Street 1:4816 PINEVIEW WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531
Practice Address - Country:US
Practice Address - Phone:650-380-4862
Practice Address - Fax:510-581-6679
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18206208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G182060Medicaid
CA00G182060Medicaid