Provider Demographics
NPI:1477041952
Name:BUCHALTER, IRA HAROLD
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:HAROLD
Last Name:BUCHALTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 TEMPRANILLO LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5291
Mailing Address - Country:US
Mailing Address - Phone:925-204-5099
Mailing Address - Fax:
Practice Address - Street 1:2029 TEMPRANILLO LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5291
Practice Address - Country:US
Practice Address - Phone:925-204-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21971207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty