Provider Demographics
NPI:1598727380
Name:BUCKMAN, DAVID D (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:BUCKMAN
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 1:2320 WILMA RUDOLPH BLVD.
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8960
Mailing Address - Country:US
Mailing Address - Phone:931-645-1564
Mailing Address - Fax:931-645-3842
Practice Address - Street 1:2320 WILMA RUDOLPH BLVD.
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8960
Practice Address - Country:US
Practice Address - Phone:931-645-1564
Practice Address - Fax:931-645-3842
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD019054207Q00000X, 207PE0004X
AZ51283207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
4236350OtherBCBS
AZ154236Medicaid
B59046Medicare UPIN