Provider Demographics
NPI:1851481824
Name:BUCKETT, WILLIAM EDWARD (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:BUCKETT
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Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:1054 MARTIN LUTHER KING DR
Mailing Address - Street 2:STE 124
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3000
Mailing Address - Country:US
Mailing Address - Phone:618-533-8700
Mailing Address - Fax:618-533-8701
Practice Address - Street 1:1054 MARTIN LUTHER KING DR
Practice Address - Street 2:STE 124
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3000
Practice Address - Country:US
Practice Address - Phone:618-533-8700
Practice Address - Fax:618-533-8701
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-11-12
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Provider Licenses
StateLicense IDTaxonomies
NY009118363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical