Provider Demographics
NPI:1184424236
Name:BUCKLEY, ANTHONY
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BUCKLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17635 JAYCEE RD
Mailing Address - Street 2:
Mailing Address - City:IOWA
Mailing Address - State:LA
Mailing Address - Zip Code:70647-6081
Mailing Address - Country:US
Mailing Address - Phone:337-965-6292
Mailing Address - Fax:
Practice Address - Street 1:17635 JAYCEE RD
Practice Address - Street 2:
Practice Address - City:IOWA
Practice Address - State:LA
Practice Address - Zip Code:70647-6081
Practice Address - Country:US
Practice Address - Phone:337-965-6292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008842893172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver