Provider Demographics
NPI:1083760599
Name:BUCK, DENISE L (M D)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:BUCK
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8793 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5111
Mailing Address - Country:US
Mailing Address - Phone:314-968-0700
Mailing Address - Fax:314-961-0909
Practice Address - Street 1:8793 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5111
Practice Address - Country:US
Practice Address - Phone:314-968-0700
Practice Address - Fax:314-961-0909
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO108334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203822606Medicaid
MO080187851OtherRAILROAD MEDICARE
MO203822606Medicaid
MO080187851OtherRAILROAD MEDICARE