Provider Demographics
NPI:1073812251
Name:BUCK, STACIE LYNN (DPM)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:LYNN
Last Name:BUCK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 DIXON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-7229
Mailing Address - Country:US
Mailing Address - Phone:540-374-5261
Mailing Address - Fax:540-374-5066
Practice Address - Street 1:1500 DIXON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-7229
Practice Address - Country:US
Practice Address - Phone:540-374-5261
Practice Address - Fax:540-374-5066
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-27
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301063213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist