Healthcare Provider Details

I. General information

NPI: 1699303743
Provider Name (Legal Business Name): TAYLOR AUSTIN BUUCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 MONTLAKE BLVD
SEATTLE WA
98195-2531
US

IV. Provider business mailing address

PO BOX 354060
SEATTLE WA
98195-4060
US

V. Phone/Fax

Practice location:
  • Phone: 206-520-5000
  • Fax:
Mailing address:
  • Phone: 206-598-3294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD.MD.61682107
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4351046503
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: