Provider Demographics
NPI:1730166828
Name:BUCK, RICHARD OTIS (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:OTIS
Last Name:BUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2201 WILLAMETTE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3091
Mailing Address - Country:US
Mailing Address - Phone:541-683-0730
Mailing Address - Fax:541-683-4411
Practice Address - Street 1:2201 WILLAMETTE ST
Practice Address - Street 2:SUITE C
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3091
Practice Address - Country:US
Practice Address - Phone:541-683-0730
Practice Address - Fax:541-683-4411
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD11569207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR030005151OtherRAILROAD MEDICARE
OR041764Medicaid
831390001OtherBLUE CROSS
C92307OtherPROVIDENCE
OR041764Medicaid
831390001OtherBLUE CROSS