Provider Demographics
NPI:1922056480
Name:BUCKLES, STEVEN MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
Last Name:BUCKLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3404 WATERFORD CT
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-4552
Mailing Address - Country:US
Mailing Address - Phone:816-279-8431
Mailing Address - Fax:816-279-4008
Practice Address - Street 1:3949 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3649
Practice Address - Country:US
Practice Address - Phone:816-279-4882
Practice Address - Fax:816-279-4008
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO105609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2324148OtherAETNA
MO254381OtherHEALTHLINK
MO431898609OtherTRICARE
MO431898609OtherHEALTH CHOICE
MO10001146903OtherCOMMUNITY HEALTH PLAN
MO21061107OtherBCBS OF KC
MO245101613Medicaid
MOP00245635OtherRAILROAD MEDICARE
MOE22961Medicare UPIN
MO10001146903OtherCOMMUNITY HEALTH PLAN