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General NPI Number Information
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NPI Number | 1407832116
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Entity Type | Individual
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Provider Name | LEANNE IRENE BUCK PA C
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Gender | Female
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 20 W NORTH ST
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City | CORTEZ
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State | CO
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Zip | 81321-3117
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Country | US
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Telephone | 970-565-7011
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Fax | 970-565-3277
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Provider Business Mailing Address
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Address Line | 20 W NORTH ST
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City | CORTEZ
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State | CO
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Zip | 81321-3117
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Country | US
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Telephone | 970-565-7011
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Fax | 970-565-3277
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | AK605
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0004538
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License Number State | CO
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