Provider Demographics
NPI:1427054253
Name:BUCK, GARY B (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:B
Last Name:BUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 N BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-9120
Mailing Address - Country:US
Mailing Address - Phone:856-740-4888
Mailing Address - Fax:856-740-0559
Practice Address - Street 1:510 E LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360
Practice Address - Country:US
Practice Address - Phone:856-740-4888
Practice Address - Fax:856-740-0558
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-069808-L207L00000X
NJ25MA06131600207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1797360Medicaid
PA1797360Medicaid
G54767Medicare UPIN