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Organization

F GRANT BUCKLE MD A PROFESSIONAL CORP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
FRANK GRANT BUCKLE M.D. (PRESIDENT)
(213) 977-1246
Entity
Organization

Contact information

Practice address
1245 WILSHIRE BLVD STE 511, LOS ANGELES, CA 90017-4805
(213) 977-1246
Mailing address
1245 WILSHIRE BLVD, SUITE 511, LOS ANGELES, CA 90017-4810

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A24871
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00A248711
CA
Enumeration date
06/01/2007
Last updated
10/31/2008
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