Provider Demographics
NPI:1093709172
Name:BUCK, GRAY C III (MD)
Entity Type:Individual
Prefix:
First Name:GRAY
Middle Name:C
Last Name:BUCK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 10TH AVE S
Mailing Address - Street 2:SUITE 403
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1200
Mailing Address - Country:US
Mailing Address - Phone:205-933-7946
Mailing Address - Fax:205-930-2779
Practice Address - Street 1:2700 10TH AVE S
Practice Address - Street 2:SUITE 403
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1200
Practice Address - Country:US
Practice Address - Phone:205-933-7946
Practice Address - Fax:205-930-2779
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012612208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL582517165OtherTAX ID
AL009949225Medicaid
AL582517165OtherTAX ID