| Shannon Patrick Buck, DO | |
|
1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 | |
| (210) 292-8200 | |
| (210) 292-3781 |
| Full Name | Shannon Patrick Buck |
|---|---|
| Gender | Male |
| Speciality | Dermatology |
| Location | 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578895744 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207ND0101X | Dermatology - Mohs-micrographic Surgery | S0144 (Texas) | Secondary |
| 207N00000X | Dermatology | S0144 (Texas) | Primary |
| Entity Name | The University Of Texas Health Science Center At San Antonio |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1720051717 PECOS PAC ID: 0042128548 Enrollment ID: O20040607000664 |
| Entity Name | Epiphany Dermatology Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1043615263 PECOS PAC ID: 3971827791 Enrollment ID: O20150126001498 |
| Mailing Address | Practice Location Address |
|---|---|
| Shannon Patrick Buck, DO 7300 Ranch Road 2222, Bldg 1, Ste 200, Austin, TX 78730 Ph: (512) 628-0465 | Shannon Patrick Buck, DO 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Ph: (210) 292-8200 |
Heidi Dearborn, DO Dermatology Medicare: Medicare Enrolled Practice Location: 1100 Wilford Hall Loop, Jbsa Lackland, TX 78236 Phone: 210-292-5350 | |
Dr. Amanda J Laska-trump, M.D. Dermatology Medicare: Medicare Enrolled Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-6255 Fax: 210-292-7934 | |
Dr. Christopher M Edens, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-6225 | |
Dr. Wendi Wohltmann, M.D. Dermatology Medicare: Medicare Enrolled Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-5350 | |
Jared Eldon Roberts, M.D. Dermatology Medicare: Not Enrolled in Medicare Practice Location: 1100 Wilford Hall Loop Bldg 4554, Jbsa Lackland, TX 78236 Phone: 210-292-6255 Fax: 210-292-7934 | |
Mr. Jarrod Paul Odom, MD Dermatology Medicare: Not Enrolled in Medicare Practice Location: 1100 Wilford Hall Loop, Jbsa Lackland, TX 78236 Phone: 210-292-5350 |