Provider Demographics
NPI:1003864737
Name:BUCHANAN, DENNIS J (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LAGUNA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3601
Mailing Address - Country:US
Mailing Address - Phone:714-992-5350
Mailing Address - Fax:714-992-8156
Practice Address - Street 1:101 LAGUNA RD STE 100
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3601
Practice Address - Country:US
Practice Address - Phone:714-992-5350
Practice Address - Fax:714-992-8156
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG42457207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48973Medicare UPIN
CAWG42457BMedicare ID - Type Unspecified
CAFW873Medicare PIN