Individual
KEITH D BUCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5 MOBILE INFIRMARY CIR, MOBILE, AL 36607-3513
(251) 432-4497
(251) 432-0577
Mailing address
PO BOX 934369, ATLANTA, GA 31193-0001
(800) 897-6169
(800) 897-6170
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
1-088997
AL
367500000X
Certified Registered Nurse Anesthetist
Primary
1088997
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009941427
—
AL
05
—
009941428
—
AL
05
—
009941429
—
AL
05
—
009941431
—
AL
01
—
051539202
BC OF AL
AL
01
—
051539203
BC OF AL
AL
01
—
051539204
BC OF AL
AL
Enumeration date
01/08/2007
Last updated
02/11/2008
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