Basic Information
| Provider Information | |||||||||
| NPI: | 1215294327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCKNER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | WORDY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15688 MEADOW CT | ||||||||
| Address2: | |||||||||
| City: | PLATTE CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640797235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177731945 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2301 HOLMES ST | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164044175 | ||||||||
| FaxNumber: | 8164040003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2012 | ||||||||
| LastUpdateDate: | 08/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2014021729 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 157401 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1215294327 | 05 | MO | MEDICAID |