Individual
DR. KEVIN RAY BUCKWALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7151 CASCADE VALLEY CT STE 200, LAS VEGAS, NV 89128-0498
(702) 568-8450
(702) 568-8451
Mailing address
1280 MONUMENT BLVD, # 1, CONCORD, CA 94520-4405
(916) 733-6993
(916) 733-6989
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
A63401
CA
208600000X
Surgery Physician
A63401
CA
208D00000X
General Practice Physician
Primary
8476
NV
208D00000X
General Practice Physician
A63401
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A634010
MCARE PTAN
CA
01
—
8476
LICENSE
NV
01
—
A63401
LICENSE
CA
Enumeration date
06/30/2005
Last updated
03/17/2018
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