Provider Demographics
NPI:1851602338
Name:BUCK, THOMAS RAYMOND (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RAYMOND
Last Name:BUCK
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:677 VT ROUTE 7A
Mailing Address - Street 2:
Mailing Address - City:SHAFTSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05262-9548
Mailing Address - Country:US
Mailing Address - Phone:802-442-8531
Mailing Address - Fax:802-442-1503
Practice Address - Street 1:677 VT ROUTE 7A
Practice Address - Street 2:
Practice Address - City:SHAFTSBURY
Practice Address - State:VT
Practice Address - Zip Code:05262-9548
Practice Address - Country:US
Practice Address - Phone:802-442-8531
Practice Address - Fax:802-442-1503
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY008599363AM0700X
VT0031117363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical