Individual
THERESA M BUCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10201 SE MAIN ST STE 29, PORTLAND, OR 97216-2937
(503) 261-4475
(503) 261-4476
Mailing address
PO BOX 92900, PORTLAND, OR 97292-0900
(503) 261-4475
(503) 261-4476
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
MD28008
OR
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
Primary
MD28008
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007192
—
OR
05
—
00A679360
—
CA
Enumeration date
10/03/2006
Last updated
04/12/2016
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