Provider Demographics
NPI:1851470868
Name:BUCKLEY, CHRISTOPHER JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2581 CALIF. PARK DR.
Mailing Address - Street 2:APT. 284
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928
Mailing Address - Country:US
Mailing Address - Phone:530-680-3831
Mailing Address - Fax:
Practice Address - Street 1:2581 CALIFORNIA PARK DR
Practice Address - Street 2:APT. 284
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-4012
Practice Address - Country:US
Practice Address - Phone:530-680-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15359363A00000X
CA15359363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA15359Medicaid
CAPA15359Medicaid
CA0PA153593Medicare PIN