MEDICARE: CHARLES ROSS BUCK M.D.

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	2083P0901X	Public Health & General Preventive Medicine Physician	22906	IA

General Provider Information

NPI Number	:	1598725863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES ROSS BUCK M.D.

Provider Business Mailing Address
First Line	:	540 E JEFFERSON ST
Second Line	:	SUITE 205
City	:	IOWA CITY
State	:	IA
Zip	:	52245-2479
Country	:	US
Telephone Number	:	319-339-3921
Fax Number	:	319-339-3858

Provider Business Practice Location Address
First Line	:	540 E JEFFERSON ST
Second Line	:	SUITE 205
City	:	IOWA CITY
State	:	IA
Zip	:	52245-2479
Country	:	US
Telephone Number	:	319-339-3921
Fax Number	:	319-339-3858

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/08/2007

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