Healthcare Provider Details

I. General information

NPI: 1427054253
Provider Name (Legal Business Name): GARY B BUCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E LANDIS AVE
VINELAND NJ
08360
US

IV. Provider business mailing address

2007 N BLACK HORSE PIKE
WILLIAMSTOWN NJ
08094-9120
US

V. Phone/Fax

Practice location:
  • Phone: 856-740-4888
  • Fax: 856-740-0558
Mailing address:
  • Phone: 856-740-4888
  • Fax: 856-740-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-069808-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA06131600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: