1134185150 NPI number — PETER J BUECKER MD

Table of content: PETER J BUECKER MD (NPI 1134185150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134185150 NPI number — PETER J BUECKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUECKER
Provider First Name:
PETER
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134185150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4331 CHURCHMAN AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40215-1164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-364-0902
Provider Business Mailing Address Fax Number:
502-364-0099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4331 CHURCHMAN AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40215-1164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-364-0902
Provider Business Practice Location Address Fax Number:
502-364-0099
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  35801 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50101088 . This is a "PASSPORT HEALTH PLAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P01572803 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000995097 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7556710 . This is a "AETNA PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64104680 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com