Individual
DR. JERROLD M BUCKALOO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
20903
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209036
—
SC
01
—
P00401081
RAILROAD MEDICARE ID
SC
01
—
P00727280
RAILROAD MEDICARE ID-RSFPN
SC
Enumeration date
09/14/2006
Last updated
02/12/2015
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