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General NPI Number Information
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NPI Number | 1093709172
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Entity Type | Individual
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Provider Name | GRAY C. BUCK III M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 2700 10TH AVE S SUITE 403
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City | BIRMINGHAM
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State | AL
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Zip | 35205-1200
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Country | US
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Telephone | 205-933-7946
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Fax | 205-930-2779
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Provider Business Mailing Address
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Address Line | 2700 10TH AVE S SUITE 403
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City | BIRMINGHAM
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State | AL
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Zip | 35205-1200
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Country | US
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Telephone | 205-933-7946
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Fax | 205-930-2779
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 00012612
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License Number State | AL
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