Provider Demographics
NPI:1922211085
Name:BUCKINGHAM, MARION BELL (DO)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:BELL
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 S HIAWASSEE RD
Mailing Address - Street 2:2936
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1717
Mailing Address - Country:US
Mailing Address - Phone:407-294-7755
Mailing Address - Fax:407-294-3903
Practice Address - Street 1:1039 S HIAWASSEE RD
Practice Address - Street 2:2936
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1717
Practice Address - Country:US
Practice Address - Phone:407-294-7755
Practice Address - Fax:407-294-3903
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06414Medicare ID - Type Unspecified
FLHO4397Medicare UPIN