Individual
MR. LARRY R BUCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MPA
Contact information
Practice address
600 BLUES LAKE PKWY, ROLLA, MO 65401-8022
(573) 364-8822
(573) 341-5969
Mailing address
600 BLUES LAKE PKWY, ROLLA, MO 65401-8022
(573) 364-8823
(573) 341-5969
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
112148
MO
Other
Enumeration date
10/19/2005
Last updated
11/17/2009
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