Provider Demographics
NPI:1023147675
Name:BUCKINGHAM, ROBERT L (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:BUCKINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PIRIE RD
Mailing Address - Street 2:STE D
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023
Mailing Address - Country:US
Mailing Address - Phone:805-646-0104
Mailing Address - Fax:805-646-9476
Practice Address - Street 1:115 PIRIE RD
Practice Address - Street 2:STE D
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023
Practice Address - Country:US
Practice Address - Phone:805-646-0104
Practice Address - Fax:805-646-9476
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10722Medicare ID - Type Unspecified
CAB56486Medicare UPIN