Provider Demographics
NPI:1285675439
Name:BUCHWALD, JASON DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:BUCHWALD
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 1:6027 E IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-6734
Mailing Address - Country:US
Mailing Address - Phone:480-894-5545
Mailing Address - Fax:480-515-3817
Practice Address - Street 1:23005 N 74TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7500
Practice Address - Country:US
Practice Address - Phone:888-991-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2019-0637207R00000X
NY223729207R00000X
AZ36912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ266216Medicaid
NJH17045Medicare UPIN
AZZ135383Medicare PIN
AZ266216Medicaid