Individual
KENNETH R BUCCINO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 E. MAIN STREET, SUITE C, MEDFORD, OR 97501-6041
(541) 789-4728
(541) 789-4765
Mailing address
100 E. MAIN STREET, SUITE C, MEDFORD, OR 97501-6041
(541) 789-4728
(541) 789-4765
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
MD21074
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151255
—
OR
Enumeration date
04/18/2006
Last updated
07/08/2007
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