DR. RAPHAEL A BUCKLE MD
Allergy and Immunology
Amory, Mississippi
Provider NPI: 1700867074
Provider Information:DR. RAPHAEL A BUCKLE MD
Practice Location:
900 EARL FRYE BLVD SUITE A AMORY, MS 38821 US
Tel: 662-256-9331 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 208000000X | Physicians Pediatrics | MS | 20416 |
| N | 207K00000X | Physicians Allergy & Immunology | GA | 56408 |
| N | 208000000X | Physicians Pediatrics | GA | 56408 |
Other Provider Identifiers:
| Issuer | Number | State | Type |
|---|---|---|---|
| LEGACY# | 37BBHBH | 01 | |
| 06304211 | MS | 05 | |
| 262717777A | GA | 05 | |
| ORG NPI | 1184881229 | GA | 01 |
| GROUP# | GRP7462 | 01 | |
| NPI | 1700867074 | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
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