Provider Demographics
NPI:1245227040
Name:BUCHANAN, CHRISTOPHER J (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
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 1353
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-1614
Mailing Address - Country:US
Mailing Address - Phone:719-275-4543
Mailing Address - Fax:719-275-4543
Practice Address - Street 1:33 SAVAGE LOOP
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4147
Practice Address - Country:US
Practice Address - Phone:719-275-4543
Practice Address - Fax:719-275-4543
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04333357Medicaid
COC449968Medicare PIN
CO04333357Medicaid