1609849264 NPI number — DAVID P BUCK M.D.

Table of content: DAVID P BUCK M.D. (NPI 1609849264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609849264 NPI number — DAVID P BUCK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCK
Provider First Name:
DAVID
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1609849264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3170 KETTERING BLVD BLDG B3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORAINE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45439-1924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-991-3100
Provider Business Mailing Address Fax Number:
937-223-9811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4940 COTTONVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45335-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-675-6830
Provider Business Practice Location Address Fax Number:
937-675-6835
Provider Enumeration Date:
02/13/2006

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: 207QS0010X , with the licence number:  35080389 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 35080389 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000666648 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000699778 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: H203790 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00954615 . This is a "RRMCR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2436911 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810017879 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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