Provider Demographics
NPI:1225868896
Name:BUCK, TAKUR GEORGE (MD (AZ AP PERMIT))
Entity type:Individual
Prefix:DR
First Name:TAKUR
Middle Name:GEORGE
Last Name:BUCK
Suffix:
Gender:M
Credentials:MD (AZ AP PERMIT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8183
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-0183
Mailing Address - Country:US
Mailing Address - Phone:517-980-9698
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 457
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505-0457
Practice Address - Country:US
Practice Address - Phone:928-755-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR79880207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine