| Doctor Name: | MR. GARY LEE BUCK |
| NPI Number: | 1841313418 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A. |
| License Number: | PSB 30265 |
| Business Practice Address: | 1480 Lincoln Ave San Rafael, CA - 949012084 |
| Business Phone Number: | 4154567724 |
| Business Fax Number: | 4154561050 |
| Mailing Address: | 715 Brody Pl, PETALUMA |
| State: | CA |
| Postal Code: | 949547421 |
| Phone Number: | 7077899357 |
| Fax Number: | 7077899357 |
| NPI Enumeration Date: | 04/09/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | PSB 30265 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |