Basic Information
| Provider Information | |||||||||
| NPI: | 1881692838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCK | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11881-A E COLONIAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328264723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073670064 | ||||||||
| FaxNumber: | 4073225309 | ||||||||
| Practice Location | |||||||||
| Address1: | 10829 DYLAN LOREN CIR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072737373 | ||||||||
| FaxNumber: | 4077700675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS7810 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 270276200 | 05 | FL | MEDICAID | 46011 | 01 | FL | BC/BS | OTHER | 276736 | 01 | FL | WELLCARE | OTHER |