Provider Demographics
NPI:1912041104
Name:BUCHANAN, LYNN P (DO)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:P
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:PATRICE
Other - Last Name:BUCHANAN-CHARTRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:505 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5489
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 MAIN ST FL 5
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-5489
Practice Address - Country:US
Practice Address - Phone:415-735-5804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1977207Q00000X, 208M00000X
TXK5839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092304701Medicaid
NV13528722OtherCAQH
NV13528722OtherCAQH