Individual
DR. JONATHAN BOHANNON BUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
1402 S GRAND BLVD, 14TH FLOOR FDT, SAINT LOUIS, MO 63104-1004
(314) 577-8762
(314) 577-8100
Mailing address
2340 LAFAYETTE AVE, UNIT 3K, SAINT LOUIS, MO 63104-2516
(314) 780-7625
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2021012535
MO
208M00000X
Hospitalist Physician
2021012535
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/28/2016
Last updated
08/26/2022
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