Provider Demographics
NPI:1164456646
Name:BUCHANAN, TODD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:DAVID
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:P.O. BOX 1183
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620
Mailing Address - Country:US
Mailing Address - Phone:512-858-4166
Mailing Address - Fax:512-858-4196
Practice Address - Street 1:104 MERCER
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620
Practice Address - Country:US
Practice Address - Phone:512-858-4166
Practice Address - Fax:512-858-4196
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080102184OtherRAILROAD MEDICARE
TX86210SOtherBCBS
E96706Medicare UPIN
TX86210SOtherBCBS