Provider Demographics
NPI:1467434142
Name:BUCKINGHAM, EDWARD D (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:D
Last Name:BUCKINGHAM
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:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78767-0128
Mailing Address - Country:US
Mailing Address - Phone:512-401-2500
Mailing Address - Fax:512-401-2501
Practice Address - Street 1:2745 BEE CAVES ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-401-2500
Practice Address - Fax:512-401-2501
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5468207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
144634100OtherFIRST CARE
TX8V2550OtherBCBS
276816OtherAMERIGROUP
TX163600302Medicaid
H71396Medicare UPIN
TX8V2550OtherBCBS