Healthcare Provider Details

I. General information

NPI: 1164427555
Provider Name (Legal Business Name): JAMES SAMUEL BUCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WALLACE AVE
LEITCHFIELD KY
42754
US

IV. Provider business mailing address

908 WALLACE AVE
LEITCHFIELD KY
42754-1479
US

V. Phone/Fax

Practice location:
  • Phone: 270-259-2700
  • Fax: 270-259-2717
Mailing address:
  • Phone: 270-259-2700
  • Fax: 270-259-2717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number26600
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: