Provider Demographics
NPI:1073873204
Name:WALTER S BUCK 3RD DPM LLC
Entity Type:Organization
Organization Name:WALTER S BUCK 3RD DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-257-6315
Mailing Address - Street 1:1401 N 5TH ST
Mailing Address - Street 2:STREET
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-2204
Mailing Address - Country:US
Mailing Address - Phone:215-257-6315
Mailing Address - Fax:
Practice Address - Street 1:1401 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-2204
Practice Address - Country:US
Practice Address - Phone:215-257-6315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty