Provider Demographics
NPI:1891933347
Name:BUCK, JOSEPH VICTOR III (RN)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:VICTOR
Last Name:BUCK
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:VICTOR
Other - Last Name:BUCK
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:933 LONG BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-3135
Mailing Address - Country:US
Mailing Address - Phone:618-667-9054
Mailing Address - Fax:
Practice Address - Street 1:933 LONG BRANCH RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-3135
Practice Address - Country:US
Practice Address - Phone:618-667-9054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041250591163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology