Healthcare Provider Details

I. General information

NPI: 1710156088
Provider Name (Legal Business Name): STANLEY W BUCK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD SUITE 304
SAINT LOUIS MO
63136-6132
US

IV. Provider business mailing address

11125 DUNN RD STE 411
SAINT LOUIS MO
63136-6132
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-1166
  • Fax: 314-355-9179
Mailing address:
  • Phone: 314-355-1166
  • Fax: 314-355-9179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: STANLEY BUCK
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 314-355-1166