Individual
MR. LARRY G. BUCKINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
225 MEDICAL CENTER DR, SUITE 308, PADUCAH, KY 42003-7914
(270) 441-4750
(270) 441-4770
Mailing address
225 MEDICAL CENTER DR, SUITE 308, PADUCAH, KY 42003-7914
(270) 441-4750
(270) 441-4770
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
347A
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000361080
BCBS
—
05
—
74207846
—
KY
Enumeration date
10/02/2006
Last updated
07/08/2007
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