1407968407 NPI number — WALTER S BUCK III DPM

Table of content: WALTER S BUCK III DPM (NPI 1407968407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407968407 NPI number — WALTER S BUCK III DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCK
Provider First Name:
WALTER
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
DPM
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:
1407968407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 NORTH 5TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERKASIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-257-6315
Provider Business Mailing Address Fax Number:
215-453-9030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 NORTH 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERKASIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-257-6315
Provider Business Practice Location Address Fax Number:
215-453-9030
Provider Enumeration Date:
08/31/2006

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: 213E00000X , with the licence number:  SC001455L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: SC001455L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3218 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 119879 . This is a "HI MARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0023124000 . This is a "BLUE SHILELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 05007970401 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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