Provider Demographics
NPI:1578900486
Name:BUCHANAN, CLAY THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:THOMAS
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1672 INDEPENDENCE DR STE 310
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-3982
Mailing Address - Country:US
Mailing Address - Phone:830-730-5025
Mailing Address - Fax:210-314-2149
Practice Address - Street 1:1770 STATE HIGHWAY 46 W STE 1200
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-5391
Practice Address - Country:US
Practice Address - Phone:830-730-4125
Practice Address - Fax:830-312-7896
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3602542-04Medicaid
TX360254202Medicaid
TX1578900486Medicaid