Provider Demographics
NPI:1659978609
Name:BUCK, DAVID PRICE
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PRICE
Last Name:BUCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 CRAFT ST APT 4214
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1681
Mailing Address - Country:US
Mailing Address - Phone:808-464-9726
Mailing Address - Fax:
Practice Address - Street 1:231 HERLONG AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:808-464-9726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3053363LF0000X
NC5016379363LF0000X
SCAPN.26071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily