Provider Demographics
NPI:1699896159
Name:BUCK, DAVID CRAIG (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CRAIG
Last Name:BUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3301 E ELKHORN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-6240
Mailing Address - Country:US
Mailing Address - Phone:402-390-4111
Mailing Address - Fax:402-390-4115
Practice Address - Street 1:3301 E ELKHORN DR STE 100
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-6240
Practice Address - Country:US
Practice Address - Phone:402-390-4111
Practice Address - Fax:402-390-4115
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE24066207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026130605Medicaid
NE10026130500Medicaid
IA1699896159Medicaid
NE10025800600Medicaid
NE10026130606Medicaid
NE47063010113Medicaid
NEP01670490OtherRR MEDICARE
NE10026130500Medicaid
NE099016007Medicare PIN
NE281492Medicare PIN