Organization
TUPELO PLASTIC SURGERY CLINIC OF TUPELO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT BUCKLEY (MD)
(662) 377-6630
Entity
Organization
Contact information
Practice address
4381 S EASON BLVD STE 101, LONGTOWN MEDICAL PARK, TUPELO, MS 38801-6586
(662) 377-6630
(662) 377-6635
Mailing address
450 E PRESIDENT AVE, TUPELO, MS 38801-5599
(662) 377-4685
(662) 377-2755
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00110707
—
MS
Enumeration date
08/31/2006
Last updated
02/29/2008
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