Provider Demographics
NPI:1811345093
Name:BUCKLAND, MOLLY (DO)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BUCKLAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4061
Mailing Address - Country:US
Mailing Address - Phone:406-587-4432
Mailing Address - Fax:
Practice Address - Street 1:1905 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4061
Practice Address - Country:US
Practice Address - Phone:406-587-4432
Practice Address - Fax:406-587-7015
Is Sole Proprietor?:No
Enumeration Date:2016-05-29
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101023390207N00000X
FLUO4915208D00000X
MT91884207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice