Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 5502003379 | MI |
NPI | 1003317439 |
---|---|
Provider Name | Mr. Spencer William Buck |
First Address | Ludington, MI 49431-1536 |
Second Address | Ludington, MI 49431-1536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2018 |
Last Update Date | 21/02/2018 |