Provider Demographics
NPI:1356498588
Name:BUCHANAN, DANIEL GORDON (PA-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:GORDON
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10121 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4835
Mailing Address - Country:US
Mailing Address - Phone:530-587-6011
Mailing Address - Fax:530-582-3287
Practice Address - Street 1:10121 PINE AVE
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4835
Practice Address - Country:US
Practice Address - Phone:530-587-6011
Practice Address - Fax:530-582-3287
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA885363A00000X
CA16103363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
12506506OtherCAQH
CA16103OtherSTATE LICENSE