Provider Demographics
NPI:1043296643
Name:BUCHANAN, GARY S (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:S
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:6801 EMMETT F LOWRY EXPY
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2500
Practice Address - Country:US
Practice Address - Phone:409-938-5000
Practice Address - Fax:409-938-5001
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6083207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176644608Medicaid
TX1083662787OtherBCBSTX
TX8Y0144OtherBCBSTX
TX1043296643OtherTRICARE SOUTH
TX140240635Medicaid
TX140240634Medicaid
TX176644609Medicaid
TX8F9752OtherBCBSTX PROV NO
TX8J1264Medicare PIN
TX8731B0Medicare PIN
TX1083662787Medicare PIN
TX8620B6Medicare PIN
TX1083662787OtherBCBSTX
TXE29317Medicare UPIN
TX140240635Medicaid
TX176644609Medicaid