Provider Demographics
NPI:1184754558
Name:LEONARD J BUCK MD INC
Entity type:Organization
Organization Name:LEONARD J BUCK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-698-2512
Mailing Address - Street 1:1050 ISAAC STREETS DRIVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3291
Mailing Address - Country:US
Mailing Address - Phone:419-698-2512
Mailing Address - Fax:419-698-2004
Practice Address - Street 1:1050 ISAAC STREETS DRIVE
Practice Address - Street 2:SUITE 116
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3291
Practice Address - Country:US
Practice Address - Phone:419-698-2512
Practice Address - Fax:419-698-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044078B207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2975697Medicaid
OHDG5191OtherRAILROAD MEDICARE
OHDG5191OtherRAILROAD MEDICARE
OH9211962Medicare UPIN