MEDICARE: LEANNE IRENE BUCK PA C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	AK605	AK
2	363A00000X	Physician Assistant	PA.0004538	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407832116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANNE IRENE BUCK PA C

Provider Business Mailing Address
First Line	:	20 W NORTH ST
Second Line	:
City	:	CORTEZ
State	:	CO
Zip	:	81321-3117
Country	:	US
Telephone Number	:	970-565-7011
Fax Number	:	970-565-3277

Provider Business Practice Location Address
First Line	:	20 W NORTH ST
Second Line	:
City	:	CORTEZ
State	:	CO
Zip	:	81321-3117
Country	:	US
Telephone Number	:	970-565-7011
Fax Number	:	970-565-3277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	03/17/2018

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Directions to “ LEANNE IRENE BUCK PA C” Practice Location

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