Provider Demographics
NPI:1598945214
Name:BUCKNER, CARLOS L (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:L
Last Name:BUCKNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-0128
Mailing Address - Country:US
Mailing Address - Phone:281-833-3330
Mailing Address - Fax:281-833-3323
Practice Address - Street 1:5880 ENTERPRISE STE 400
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4295
Practice Address - Country:US
Practice Address - Phone:307-333-6567
Practice Address - Fax:307-265-2860
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY8683A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY8683AOtherWY MEDICAL LICENSE
WY8683AOtherWY MEDICAL LICENSE