Provider Demographics
NPI:1649264847
Name:BUCKHORN, CARL WILLIAM (MD)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:WILLIAM
Last Name:BUCKHORN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:18200 YORBA LINDA BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4056
Mailing Address - Country:US
Mailing Address - Phone:714-646-8000
Mailing Address - Fax:714-572-2562
Practice Address - Street 1:18300 YORBA LINDA BLVD
Practice Address - Street 2:STE 204
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4052
Practice Address - Country:US
Practice Address - Phone:714-577-6031
Practice Address - Fax:714-572-2562
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2009-07-14
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Provider Licenses
StateLicense IDTaxonomies
CAG73630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF53214Medicare UPIN