NPI 1093109803

Lauren Duane Buckingham, PAC

Practitioner Physician Assistant Decatur, IL

Practice location

Address: 2300 N Edward St, Decatur, IL 62526-4163
Phone: (217) 876-3000
Mailing address: 2025 E Beltline Ave SE STE 310, Grand Rapids, MI 49546-7634

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 085.005383 (IL)

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Registry record

NPI: 1093109803
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Mar 2015
Record last updated: 5 May 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.