Provider Demographics
NPI:1093871956
Name:BUCK, OWEN DELOS (MD)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:DELOS
Last Name:BUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6578
Mailing Address - Country:US
Mailing Address - Phone:207-783-4692
Mailing Address - Fax:207-783-4694
Practice Address - Street 1:230 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6578
Practice Address - Country:US
Practice Address - Phone:207-783-4692
Practice Address - Fax:207-783-4694
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMAINE 11724207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)