Provider Demographics
NPI:1518908896
Name:BUCHANAN, RUSSELL I (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:I
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2413 W RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4306
Mailing Address - Country:US
Mailing Address - Phone:319-226-9888
Mailing Address - Fax:319-226-9889
Practice Address - Street 1:2413 W RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4306
Practice Address - Country:US
Practice Address - Phone:319-226-9888
Practice Address - Fax:319-226-9889
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA34843207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1276501Medicaid
IAH19830Medicare UPIN
IA1276501Medicaid