Individual
DARYL QUINTIN BUCKELEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3217 MABEL ST, SHREVEPORT, LA 71103-4022
(318) 631-9121
(318) 631-9126
Mailing address
PO BOX 38150, SHREVEPORT, LA 71133-8150
(318) 631-9121
(318) 631-9126
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
340576
LA
207RG0100X
Gastroenterology Physician
K6994
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2654055
—
LA
Enumeration date
06/20/2006
Last updated
07/02/2024
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