Provider Demographics
NPI:1649213216
Name:BUCK, CAMERON (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
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 1:25246 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1252
Mailing Address - Country:US
Mailing Address - Phone:425-656-4255
Mailing Address - Fax:425-656-4003
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:ER DEPT
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-228-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037345207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA930074341OtherTRAVELERS MCARE PROV #
WABU5565OtherREGENCE B/S PROV #
WA8241374Medicaid
WA185338OtherWA ST LABOR&IND PROV #
WABU5565OtherREGENCE B/S PROV #
WA8241374Medicaid