Provider Demographics
NPI:1225069164
Name:STEVE RANDALL BUCK DO PA
Entity Type:Organization
Organization Name:STEVE RANDALL BUCK DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-825-6500
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:MAYPEARL
Mailing Address - State:TX
Mailing Address - Zip Code:76064-0370
Mailing Address - Country:US
Mailing Address - Phone:972-825-6500
Mailing Address - Fax:
Practice Address - Street 1:7460 WARREN PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4169
Practice Address - Country:US
Practice Address - Phone:972-825-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1601957Medicaid
TX0007356725OtherAETNA
TX0704278OtherUNITED HEALTH CARE
TX0006NROtherHMO BLUE TEXAS
TX0006NROtherBLUE CROSS OF TEXAS
TX0006NROtherBLUE CROSS BLUE SHIELD FEDERAL
TXDG1252OtherMEDICARE RAILROAD
TX00X102Medicare PIN
TXH84327Medicare UPIN