Provider Demographics
NPI:1285755447
Name:STEVEN M. BUCKLES D.O. P.C.
Entity type:Organization
Organization Name:STEVEN M. BUCKLES D.O. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BUCKLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-279-4882
Mailing Address - Street 1:3949 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3649
Mailing Address - Country:US
Mailing Address - Phone:816-279-4882
Mailing Address - Fax:816-279-4008
Practice Address - Street 1:3949 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3649
Practice Address - Country:US
Practice Address - Phone:816-279-4882
Practice Address - Fax:816-279-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO21061107OtherBLUE CROSS BLUE SHIELD
MO1001146903OtherCOMMUNITY HEALTH PLAN
MO2324148OtherAETNA
MODD7089OtherRAILROAD RETIREMENT BOARD
MO1001146903OtherCOMMUNITY HEALTH PLAN
MOS960000Medicare ID - Type Unspecified