Provider Demographics
NPI:1578537296
Name:BUCKLES, ROSS W (DO)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:W
Last Name:BUCKLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2214 CANTERBURY DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2375
Mailing Address - Country:US
Mailing Address - Phone:785-623-2360
Mailing Address - Fax:785-623-2371
Practice Address - Street 1:2214 CANTERBURY DR
Practice Address - Street 2:SUITE 204
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2375
Practice Address - Country:US
Practice Address - Phone:785-623-2360
Practice Address - Fax:785-623-2371
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2009-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS05-30122208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100454950AMedicaid
KS100454950AMedicaid
KSH83199Medicare UPIN