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Individual

DR. RANDY SCOTT BUCKLES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
220 SOUTH WOODBINE RD, SAINT JOSEPH, MO 64506
(816) 676-1300
(816) 676-1400
Mailing address
220 SOUTH WOODBINE RD, SAINT JOSEPH, MO 64506
(816) 676-1300
(816) 676-1400

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
108739
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
080128455
RAILROAD RETIR BRD PRO #
MO
01
100001359400
CHP PROVIDER #
MO
01
10001359400
COMUUNITY HEALTH PLAN #
MO
01
2326850
AETNA PROVIDER ID
MO
01
24918021
BCKC PROVIDER ID
MO
05
249770702
MO
01
27020012
BCKC GROUP ID #
MO
01
385996
HEALTHLINK PROVIDER #
MO
01
431812629
WPS TRICARE FOR LIFE
MO
01
45828
HEALTHLINK GRP #
MO
05
505804906
MO
Enumeration date
08/04/2006
Last updated
12/30/2009
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