Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | T-1784 | MS |
N | 111NI0900X | Internist | T-1784 | MS |
N | 207RH0000X | Hematologist | 39391 | SC |
N | 207RH0003X | Hematology & Oncology | 19846 | MS |
Y | 207RH0003X | Hematology & Oncology | 39391 | SC |
NPI | 1003027764 |
---|---|
Provider Name | Dr. Tondre Buck |
First Address | Atlanta, GA 30374-3070 |
Second Address | Spartanburg, SC 29303-3040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 21/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07431002 | (05) | MS |
2359665 | (05) | LA |
393915 | (05) | SC |
SC86473365 | MEDICARE PIN (01) | SC |