Provider Demographics
NPI:1023266673
Name:BUCK, TARA ROMASANTA (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:ROMASANTA
Last Name:BUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TARA
Other - Middle Name:MARIE
Other - Last Name:ROMASANTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-660-3130
Mailing Address - Fax:918-660-3132
Practice Address - Street 1:4444 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2527
Practice Address - Country:US
Practice Address - Phone:918-660-3130
Practice Address - Fax:918-660-3132
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK264552084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200247480AMedicaid