Individual
MICHAEL LEE BUCKINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1136
(208) 422-1243
Mailing address
13191 W SCOTFIELD ST, BOISE, ID 83713-0899
(208) 938-2107
(208) 938-2117
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-308
ID
Other
Enumeration date
08/01/2006
Last updated
07/08/2007
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