Provider Demographics
NPI:1255340527
Name:BUCKNER, DAVID LEE (M D,)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:BUCKNER
Suffix:
Gender:M
Credentials:M D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:1120 E WEISGARBER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2685
Practice Address - Country:US
Practice Address - Phone:865-909-0090
Practice Address - Fax:865-909-9883
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39678207R00000X
AZ30078207R00000X
NC2007-00147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902836Medicaid
SCN00147Medicaid
SCN00147Medicaid