Provider Demographics
NPI:1619991593
Name:BUCK, THERESA A (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:BUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5771 ROOSEVELT BLVD
Mailing Address - Street 2:THE HOSPICE OF THE FLORIDA SUNCOAST
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760
Mailing Address - Country:US
Mailing Address - Phone:727-586-4432
Mailing Address - Fax:727-523-3257
Practice Address - Street 1:5771 ROOSEVELT BLVD
Practice Address - Street 2:THE HOSPICE OF THE FLORIDA SUNCOAST
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760
Practice Address - Country:US
Practice Address - Phone:727-586-4432
Practice Address - Fax:727-523-3257
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78494207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G45275Medicare UPIN
FL470802Medicare ID - Type Unspecified