Provider Demographics
NPI:1750887519
Name:BUCK, RACHEL GROETSCH (DO)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:GROETSCH
Last Name:BUCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15650 N BLACK CANYON HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4068
Mailing Address - Country:US
Mailing Address - Phone:602-866-0550
Mailing Address - Fax:602-993-5788
Practice Address - Street 1:2030 W WHISPERING WIND DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-2853
Practice Address - Country:US
Practice Address - Phone:623-869-9080
Practice Address - Fax:623-869-9090
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ009059208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program