Provider Demographics
NPI:1114345667
Name:BUCHANAN, CURTIS BLAKE (MD)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:BLAKE
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 1:12802 TAMPA OAKS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-1903
Mailing Address - Country:US
Mailing Address - Phone:813-416-0551
Mailing Address - Fax:
Practice Address - Street 1:12802 TAMPA OAKS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-1903
Practice Address - Country:US
Practice Address - Phone:813-416-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131632207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty