Provider Demographics
NPI:1396183703
Name:BUCKLEY, BRIAN (MD MPH)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 N MONTEREY ST
Mailing Address - Street 2:APT. 106
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1586
Mailing Address - Country:US
Mailing Address - Phone:516-661-7575
Mailing Address - Fax:
Practice Address - Street 1:12291 WASHINGTON BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2500
Practice Address - Country:US
Practice Address - Phone:562-698-0811
Practice Address - Fax:562-789-4339
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA134294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine