Organization
MIRAGE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY R BUCKNER D.C. (OWNER)
(602) 421-2730
Entity
Organization
Contact information
Practice address
10046 N METRO PKWY W, SUITE 115, PHOENIX, AZ 85051-1437
(602) 674-5515
(602) 674-3029
Mailing address
1001 E WARNER RD, SUITE 107, TEMPE, AZ 85284-3224
(480) 264-3744
(480) 264-2075
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
5988
AZ
363LF0000X
Family Nurse Practitioner
AP4986
AZ
364SF0001X
Family Health Clinical Nurse Specialist
AP2828
AZ
Other
Enumeration date
11/13/2013
Last updated
11/13/2013
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