Provider Demographics
NPI:1205942745
Name:BUCKLEY, JOHN EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:51 WEST 84TH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80260-4882
Mailing Address - Country:US
Mailing Address - Phone:303-427-1601
Mailing Address - Fax:303-426-6412
Practice Address - Street 1:51 WEST 84TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80260-4882
Practice Address - Country:US
Practice Address - Phone:303-427-1601
Practice Address - Fax:303-426-6412
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO26803207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01268036Medicaid
D24848Medicare UPIN
COCF7018Medicare PIN