Individual
IRENE BUCKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1967 HOSPITAL DR, CLARKSDALE, MS 38614
(662) 624-5481
Mailing address
1967 HOSPITAL DR, CLARKSDALE, MS 38614-7203
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16074
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119669
—
MS
Enumeration date
07/19/2006
Last updated
01/14/2019
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