MEDICARE: DAVID P 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	207QS0010X	Sports Medicine (Family Medicine) Physician	35080389	OH
2	207Q00000X	Family Medicine Physician	35080389	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	H203790	OTHER	OH	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000666648	OTHER	OH	ANTHEM
2	000000699778	OTHER	OH	ANTHEM
4	P00954615	OTHER	OH	RRMCR
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609849264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID P BUCK M.D.

Provider Business Mailing Address
First Line	:	3170 KETTERING BLVD BLDG B3
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1924
Country	:	US
Telephone Number	:	937-991-3100
Fax Number	:	937-223-9811

Provider Business Practice Location Address
First Line	:	4940 COTTONVILLE RD
Second Line	:
City	:	JAMESTOWN
State	:	OH
Zip	:	45335-1522
Country	:	US
Telephone Number	:	937-675-6830
Fax Number	:	937-675-6835

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	03/10/2021

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Directions to “ DAVID P BUCK M.D.” Practice Location

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