Provider Demographics
NPI:1699068387
Name:BUCKNER, JAMES WILLIS II (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIS
Last Name:BUCKNER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7142 N 27TH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-8469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9212 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2416
Practice Address - Country:US
Practice Address - Phone:480-999-4954
Practice Address - Fax:480-999-4712
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ52872207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ203338Medicaid