Basic Information
| Provider Information | |||||||||
| NPI: | 1801887815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCK | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | KENTON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 25TH ST S | ||||||||
| Address2: | BMG ADMIN | ||||||||
| City: | GREAT FALLS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 594055183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067318888 | ||||||||
| FaxNumber: | 4067318318 | ||||||||
| Practice Location | |||||||||
| Address1: | 2960 N WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | HELENA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 596021210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063892555 | ||||||||
| FaxNumber: | 4064432261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 10/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 8420 | MT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000032368 | 05 | MT | MEDICAID | 810348783 | 01 | MT | BILLING TAX I.D. | OTHER |