Individual
DR. RAPHAEL A BUCKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 EARL FRYE BLVD, SUITE A, AMORY, MS 38821-5507
(662) 256-9331
(662) 256-9335
Mailing address
900 EARL FRYE BLVD, SUITE A, AMORY, MS 38821-5507
(662) 256-9331
(662) 256-9336
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
56408
GA
208000000X
Pediatrics Physician
Primary
20416
MS
208000000X
Pediatrics Physician
56408
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06304211
—
MS
01
—
1184881229
ORG NPI
GA
01
—
1700867074
NPI
—
05
—
262717777A
—
GA
01
—
37BBHBH
LEGACY#
—
01
—
GRP7462
GROUP#
—
Enumeration date
11/14/2005
Last updated
03/02/2010
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