Provider Demographics
NPI:1255568689
Name:BUCKLEY, JAMI LEA GANN (MD)
Entity type:Individual
Prefix:DR
First Name:JAMI
Middle Name:LEA GANN
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMI
Other - Middle Name:LEA
Other - Last Name:GANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2080 CHILD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32214-5005
Mailing Address - Country:US
Mailing Address - Phone:904-546-7084
Mailing Address - Fax:904-542-3270
Practice Address - Street 1:2080 CHILD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-1098
Practice Address - Country:US
Practice Address - Phone:410-212-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-343592083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace MedicineGroup - Single Specialty