Individual
MR. TAVIS SCOTT BUCKINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
USS NEW ORLEANS (LPD 18) FPO AP 96673-1701, COMMANDING OFFICER, SAN DIEGO, CA 92123
(619) 849-1480
Mailing address
4837 SHIELDS ST, SAN DIEGO, CA 92124-2930
(858) 822-8904
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
CA
Other
Enumeration date
05/15/2007
Last updated
07/08/2007
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