Individual
KENT PAUL VANBUECKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
96 15TH ST NW, SUITE 111, NORTON, VA 24273-1620
(276) 439-1463
(276) 439-1464
Mailing address
PO BOX 5127, JOHNSON CITY, TN 37602-5127
(423) 952-2122
(423) 952-2145
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101255623
VA
207X00000X
Orthopaedic Surgery Physician
MD00026111
WA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD0002611
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437195377
—
VA
01
—
4586750
AETNA
—
01
—
P01415097
RR MEDICARE
VA
05
—
Q004984
—
TN
Enumeration date
06/21/2006
Last updated
03/07/2023
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