Provider Demographics
NPI:1659402196
Name:BUCKLEY, CHRISTOPHER M (DO)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:M
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:495 BRICKELL AVE APT 2309
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2787
Mailing Address - Country:US
Mailing Address - Phone:859-576-5774
Mailing Address - Fax:
Practice Address - Street 1:2500 HOSPITAL BLVD STE 280
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4918
Practice Address - Country:US
Practice Address - Phone:770-754-0787
Practice Address - Fax:770-755-5890
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075969207ND0101X
KY02910207ND0101X
FLOS9788207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I40387Medicare UPIN