Provider Demographics
NPI:1790745735
Name:BUCKLEY, TIMOTHY NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:NEIL
Last Name:BUCKLEY
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:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-752-5608
Mailing Address - Fax:
Practice Address - Street 1:2901 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1851
Practice Address - Country:US
Practice Address - Phone:360-788-6993
Practice Address - Fax:360-715-8996
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1790745735Medicaid
WA0188098OtherL&I/CRIME VICTIMS
WA4582293OtherAETNA
WA9041BUOtherREGENCE
WA0188098OtherL&I/CRIME VICTIMS
WA1790745735Medicaid