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Individual

MARK JAY BUCKSBAUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
69 ALLEN ST, STE 9, RUTLAND, VT 05701-4564
(417) 875-3000
Mailing address
69 ALLEN ST, STE 9, RUTLAND, VT 05701-4564
(417) 875-3000

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
0420007956
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0009492
VT
05
1215997697
MO
Enumeration date
03/28/2006
Last updated
10/23/2019
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