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General NPI Number Information
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NPI Number | 1730625799
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Entity Type | Individual
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Provider Name | SAMARA GWEN BUCK PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/16/2017
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 1670 E SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49444-1863
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Country | US
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Telephone | 231-672-2400
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Fax | 231-672-2401
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Provider Business Mailing Address
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Address Line | 3159 ROOSEVELT RD
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City | MUSKEGON
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State | MI
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Zip | 49441-3907
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Country | US
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Telephone | 231-233-7981
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Fax |
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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 | 5601008046
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License Number State | MI
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