Healthcare Provider Details

I. General information

NPI: 1750547352
Provider Name (Legal Business Name): DONALD WILLIAM BUCK II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2008
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD STE 365B
SAINT LOUIS MO
63128-2178
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 636-525-6080
  • Fax:
Mailing address:
  • Phone: 314-364-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number2013037311
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2013037311
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: