1730166828 NPI number — DR. RICHARD OTIS BUCK MD

Table of content: MRS. KATHERINE HIRSCH (NPI 1235420845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730166828 NPI number — DR. RICHARD OTIS BUCK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCK
Provider First Name:
RICHARD
Provider Middle Name:
OTIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730166828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2201 WILLAMETTE ST
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97405-3091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-683-0730
Provider Business Mailing Address Fax Number:
541-683-4411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 WILLAMETTE ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97405-3091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-683-0730
Provider Business Practice Location Address Fax Number:
541-683-4411
Provider Enumeration Date:
12/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  MD11569 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 030005151 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 041764 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 831390001 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: C92307 . This is a "PROVIDENCE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com