Provider Demographics
NPI:1407851132
Name:BUCKMAN, JOHN ARTHUR (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ARTHUR
Last Name:BUCKMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-771-0304
Mailing Address - Fax:928-458-2039
Practice Address - Street 1:12 HOPE DR
Practice Address - Street 2:
Practice Address - City:BAGDAD
Practice Address - State:AZ
Practice Address - Zip Code:86321
Practice Address - Country:US
Practice Address - Phone:928-633-4111
Practice Address - Fax:928-633-3376
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10431363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR95136Medicare UPIN