Individual
DR. JERROLD M BUCKALOO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1175 COOK RD, SUITE 215, ORANGEBURG, SC 29118-8201
(803) 395-3837
(803) 536-5122
Mailing address
1175 COOK RD, SUITE 215, ORANGEBURG, SC 29118-8201
(803) 395-3837
(803) 536-5122
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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