Provider Demographics
NPI:1164427555
Name:BUCK, JAMES SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SAMUEL
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 1:908 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1479
Mailing Address - Country:US
Mailing Address - Phone:270-259-2700
Mailing Address - Fax:270-259-2717
Practice Address - Street 1:910 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754
Practice Address - Country:US
Practice Address - Phone:270-259-2700
Practice Address - Fax:270-259-2717
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0700225OtherUNITED HEALTHCARE
KY610673930POtherHUMANA
KY610673930OtherEMPLOYER ID
KY64266000Medicaid
KY160030393OtherRAILROAD
KY1048741OtherPASSPORT
KY16638OtherBLUE CROSS/BLUE SHIELD
KY610673930POtherHUMANA
KY64266000Medicaid