Healthcare Provider Details

I. General information

NPI: 1801006945
Provider Name (Legal Business Name): KATHRYN D BUCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E. BANDERA RD. SUITE 304
BOERNE TX
78006
US

IV. Provider business mailing address

124 E. BANDERA RD. SUITE 304
BOERNE TX
78006
US

V. Phone/Fax

Practice location:
  • Phone: 830-816-5055
  • Fax:
Mailing address:
  • Phone: 830-816-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberH3300
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: