MEDICARE: BRIAN C. BUCK, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204R00000X	Electrodiagnostic Medicine Physician	H4878	TX
2	208100000X	Physical Medicine & Rehabilitation Physician	H4878	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316196082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN C. BUCK, M.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 160940
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78716-0940
Country	:	US
Telephone Number	:	512-279-2386
Fax Number	:	512-279-2387

Provider Business Practice Location Address
First Line	:	4201 BEE CAVE ROAD
Second Line	:	SUITE C-102
City	:	AUSTIN
State	:	TX
Zip	:	78746-6493
Country	:	US
Telephone Number	:	512-279-2386
Fax Number	:	512-279-2387

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN C. BUCK
Credential	:	M.D.
Telephone Number	:	512-279-2386

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	05/12/2011

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