Organization
BUCKNER PROSTHETIC AND ORTHOTIC LABORATORIES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN L BUCKNER C.P.O. (OWNER)
(601) 944-1130
Entity
Organization
Contact information
Practice address
2 OLD RIVER PL, SUITE D, JACKSON, MS 39202-3435
(601) 944-1130
(601) 355-7476
Mailing address
2 OLD RIVER PL, SUITE D, JACKSON, MS 39202-3435
(601) 944-1130
(601) 355-7476
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
224P00000X
Prosthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00040395
—
MS
Enumeration date
09/08/2005
Last updated
10/04/2013
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