Provider Demographics
NPI:1083646830
Name:BUCHANAN, YVONNE M (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:M
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BROOKFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-9562
Mailing Address - Country:US
Mailing Address - Phone:352-874-8407
Mailing Address - Fax:353-383-0796
Practice Address - Street 1:300 BROOKFIELD AVE
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-9562
Practice Address - Country:US
Practice Address - Phone:352-874-8407
Practice Address - Fax:353-383-0796
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038340600Medicaid
110059706OtherRRMC
FL038340600Medicaid
FL09226Medicare ID - Type Unspecified