Provider Demographics
NPI:1982657060
Name:BUCKLEY, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2005
Practice Address - Country:US
Practice Address - Phone:619-295-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG573832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G573830Medicaid
CAWG57383MMedicare PIN
CAWG57383NMedicare PIN
E24923Medicare UPIN
CAWG57383HMedicare PIN
CAWG57383OMedicare PIN
CA300069450Medicare PIN
CA00G573830Medicaid
CAWG57383SMedicare PIN
CAWG57383QMedicare PIN
CAWG57383RMedicare PIN
CA00G573831Medicare PIN
CAWG57383PMedicare PIN
CAWG57383JMedicare PIN