Provider Demographics
NPI:1275681355
Name:BUCKNER, DOROTHY J (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:J
Last Name:BUCKNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2376
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95031-2376
Mailing Address - Country:US
Mailing Address - Phone:408-356-8150
Mailing Address - Fax:
Practice Address - Street 1:2577 SAMARITAN DR
Practice Address - Street 2:SUITE 820
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4100
Practice Address - Country:US
Practice Address - Phone:408-356-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24510174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42285Medicare UPIN
CA00G245100Medicare ID - Type UnspecifiedDOROTHY J. BUCKNER, M.D.