Provider Demographics
NPI:1710156088
Name:STANLEY W BUCK MD PC
Entity Type:Organization
Organization Name:STANLEY W BUCK MD PC
Other - Org Name:RENAL CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-355-1166
Mailing Address - Street 1:11125 DUNN RD STE 411
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6132
Mailing Address - Country:US
Mailing Address - Phone:314-355-1166
Mailing Address - Fax:314-355-9179
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:SUITE 304
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-355-1166
Practice Address - Fax:314-355-9179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000011798Medicare PIN