Provider Demographics
NPI:1518945724
Name:BUCCO, RICHARD ANTHONY JR (MD, PHD, FASAM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:BUCCO
Suffix:JR
Gender:M
Credentials:MD, PHD, FASAM
Other - Prefix:
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Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:800-480-5243
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:1304 13TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4359
Practice Address - Country:US
Practice Address - Phone:256-580-7750
Practice Address - Fax:256-580-7751
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2023-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL27216207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H70428Medicare UPIN