Provider Demographics
NPI:1497038913
Name:MARK BUCKNER MD PA
Entity Type:Organization
Organization Name:MARK BUCKNER MD PA
Other - Org Name:ONE MEDICAL, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-868-9565
Mailing Address - Street 1:913 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2831
Mailing Address - Country:US
Mailing Address - Phone:903-868-9565
Mailing Address - Fax:903-893-8916
Practice Address - Street 1:913 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2831
Practice Address - Country:US
Practice Address - Phone:903-868-9565
Practice Address - Fax:903-893-8916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1898261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care