Provider Demographics
NPI:1699899443
Name:BUCKLEY, JULIE A (MD, FAAP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5270 PALM VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3200
Mailing Address - Country:US
Mailing Address - Phone:904-543-1288
Mailing Address - Fax:904-543-1289
Practice Address - Street 1:5270 PALM VALLEY RD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3200
Practice Address - Country:US
Practice Address - Phone:904-543-1288
Practice Address - Fax:904-543-1289
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65677208000000X
GA057441208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G13048Medicare UPIN