Provider Demographics
NPI:1396747473
Name:BUCK, BRIAN C (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:BUCK
Suffix:
Gender:M
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:PO BOX 160940
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-0940
Mailing Address - Country:US
Mailing Address - Phone:512-279-2386
Mailing Address - Fax:512-279-2387
Practice Address - Street 1:4201 BEE CAVE ROAD
Practice Address - Street 2:SUITE C-102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6493
Practice Address - Country:US
Practice Address - Phone:512-279-2386
Practice Address - Fax:512-279-2387
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4878204R00000X, 208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134872410Medicaid
TX134872410Medicaid
TXC13907Medicare UPIN