Provider Demographics
NPI:1043209000
Name:BUCHALTER, GREGORY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MICHAEL
Last Name:BUCHALTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1650 COCHRANE CIR
Mailing Address - Street 2:
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4613
Mailing Address - Country:US
Mailing Address - Phone:719-524-6399
Mailing Address - Fax:719-503-7059
Practice Address - Street 1:1625 MEDICAL CENTER PT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8731
Practice Address - Country:US
Practice Address - Phone:719-635-5148
Practice Address - Fax:719-667-4219
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2015-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO42644207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65208510Medicaid
CO533758Medicare PIN
CO65208510Medicaid