Provider Demographics
NPI:1669479184
Name:ROBERT L BUCKINGHAM M D INC
Entity Type:Organization
Organization Name:ROBERT L BUCKINGHAM M D INC
Other - Org Name:OJAI VALLEY INTERNAL MEDICINE GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUCKINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:805-646-0104
Mailing Address - Street 1:115 PIRIE RD
Mailing Address - Street 2:#D
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3100
Mailing Address - Country:US
Mailing Address - Phone:805-646-0104
Mailing Address - Fax:805-646-9476
Practice Address - Street 1:115 PIRIE RD
Practice Address - Street 2:#D
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3100
Practice Address - Country:US
Practice Address - Phone:805-646-0104
Practice Address - Fax:805-646-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39064207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G390640Medicaid
CA00G390640Medicaid
CAB56486Medicare UPIN