Healthcare Provider Details

I. General information

NPI: 1528402435
Provider Name (Legal Business Name): BUCK ANDREU SCOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S 11TH ST
LAKE WALES FL
33853
US

IV. Provider business mailing address

11945 SAN JOSE BLVD STE 300
JACKSONVILLE FL
32223-1627
US

V. Phone/Fax

Practice location:
  • Phone: 863-679-2707
  • Fax: 863-676-3621
Mailing address:
  • Phone: 904-396-1725
  • Fax: 904-396-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME134261
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: