Healthcare Provider Details

I. General information

NPI: 1609849264
Provider Name (Legal Business Name): DAVID P BUCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 COTTONVILLE RD
JAMESTOWN OH
45335-1522
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B3
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-675-6830
  • Fax: 937-675-6835
Mailing address:
  • Phone: 937-991-3100
  • Fax: 937-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35080389
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35080389
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: