Individual
DR. RANDY L BUCKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
402 BLACK HILLS LN SW STE B, OLYMPIA, WA 98502-8146
(360) 754-4837
(360) 754-7304
Mailing address
1401 MARVIN RD NE, #307 PMB 266, LACEY, WA 98516-5709
(360) 491-5055
(360) 491-5890
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
WAOP00001204
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0127421
L&I
WA
05
—
1106996
—
WA
01
—
BU9119
REGENCE
WA
Enumeration date
08/02/2006
Last updated
07/09/2007
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