Individual
SHANNON PATRICK BUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236
(210) 292-8200
(210) 292-3781
Mailing address
7300 RANCH ROAD 2222, BLDG 1, STE 200, AUSTIN, TX 78730
(512) 628-0465
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
S0144
TX
207ND0101X
MOHS-Micrographic Surgery Physician
S0144
TX
Other
Enumeration date
02/12/2010
Last updated
10/11/2024
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