Individual
LEANNE IRENE BUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
20 W NORTH ST, CORTEZ, CO 81321-3117
(970) 565-7011
(970) 565-3277
Mailing address
20 W NORTH ST, CORTEZ, CO 81321-3117
(970) 565-7011
(970) 565-3277
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
AK605
AK
363A00000X
Physician Assistant
Primary
PA.0004538
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16480821
—
NM
05
—
76830080
—
CO
Enumeration date
12/15/2005
Last updated
03/17/2018
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