Healthcare Provider Details

I. General information

NPI: 1518945724
Provider Name (Legal Business Name): RICHARD ANTHONY BUCCO JR. MD, PHD, FASAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 05/08/2023
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 13TH AVE SE
DECATUR AL
35601-4359
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 256-580-7750
  • Fax: 256-580-7751
Mailing address:
  • Phone: 800-480-5243
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27216
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number27216
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: