Provider Demographics
NPI:1194702522
Name:BUCKMASTER, MARK ALAN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:BUCKMASTER
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 1:703 VOLKER HL
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0001
Mailing Address - Country:US
Mailing Address - Phone:205-939-9235
Mailing Address - Fax:205-939-9936
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:SUITE 420 ACC
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-939-9235
Practice Address - Fax:205-939-9936
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19298207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051501388OtherBLUE CROSS BLUE SHIELD
AL051501388Medicaid
ALB65178Medicare UPIN
AL051501388Medicare ID - Type UnspecifiedMEDICARE