Provider Demographics
NPI:1124087804
Name:BUCK, RUTH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH ANN
Middle Name:
Last Name:BUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 GRATIOT RD
Mailing Address - Street 2:STE B
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-6064
Mailing Address - Country:US
Mailing Address - Phone:989-797-2825
Mailing Address - Fax:
Practice Address - Street 1:5820 GRATIOT RD
Practice Address - Street 2:STE B
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6064
Practice Address - Country:US
Practice Address - Phone:989-797-2825
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7035371OtherAETNA
MI4411499Medicaid
MI0807311482OtherBLUE CROSS
MI0807311482OtherBLUE CARE NETWORK
MI7035371OtherAETNA
MI0807311482OtherBLUE CARE NETWORK