Provider Demographics
NPI:1952396285
Name:BUCKBEE, TONI K (PA)
Entity Type:Individual
Prefix:MS
First Name:TONI
Middle Name:K
Last Name:BUCKBEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-0220
Mailing Address - Country:US
Mailing Address - Phone:906-786-4628
Mailing Address - Fax:906-789-4410
Practice Address - Street 1:2500 7TH AVE S
Practice Address - Street 2:STE 201
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1176
Practice Address - Country:US
Practice Address - Phone:906-786-4628
Practice Address - Fax:906-789-4410
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3061707Medicaid
MI0M30920P03Medicare PIN
R68587Medicare UPIN