Provider Demographics
NPI:1558342824
Name:BUCKINGHAM, ROBERT B (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
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 1:619 19TH ST S
Mailing Address - Street 2:OHB 251
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249-7013
Mailing Address - Country:US
Mailing Address - Phone:205-975-7387
Mailing Address - Fax:205-975-4662
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:OHB 251
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-7013
Practice Address - Country:US
Practice Address - Phone:205-975-7387
Practice Address - Fax:205-975-4662
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.24818207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051556388Medicaid
AL1558342824OtherTRICARE SOUTH
AL515-530057OtherBCBS
AL109846Medicaid
AL510I930647Medicare PIN
AL1558342824OtherTRICARE SOUTH
ALP00258967Medicare PIN
AL109846Medicaid