Provider Demographics
NPI:1871790816
Name:BUCKINGHAM, EDWARD TAYLOR IV (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:TAYLOR
Last Name:BUCKINGHAM
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:E. TAYLOR
Other - Middle Name:
Other - Last Name:BUCKINGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10350 E DAKOTA AVE STE B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1314
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA384502084P0800X, 2084P0804X
CODR.00469692084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO028961OtherKAISER COMMERCIAL NUMBER