Provider Demographics
NPI:1437377397
Name:BUCK, GREGORY FRANKLIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:FRANKLIN
Last Name:BUCK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1051 LOYALIST LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-9235
Mailing Address - Country:US
Mailing Address - Phone:843-881-2039
Mailing Address - Fax:
Practice Address - Street 1:96 JONATHAN LUCAS ST 210 CSB
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425
Practice Address - Country:US
Practice Address - Phone:843-792-5622
Practice Address - Fax:843-792-1707
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC501363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCS47010Medicare UPIN