Provider Demographics
NPI:1174667075
Name:BUCHWALD, ALAN LELAND (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:LELAND
Last Name:BUCHWALD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1144 RIVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-9413
Mailing Address - Country:US
Mailing Address - Phone:831-620-1156
Mailing Address - Fax:831-620-1156
Practice Address - Street 1:1555 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1705
Practice Address - Country:US
Practice Address - Phone:831-620-1156
Practice Address - Fax:831-620-1156
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2015-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG34228207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G342280Medicare PIN