Provider Demographics
NPI:1881623395
Name:BUCHANAN, BERNARD J (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:J
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1919
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42302-1919
Mailing Address - Country:US
Mailing Address - Phone:270-926-2273
Mailing Address - Fax:270-684-3212
Practice Address - Street 1:1030A BURLEW BLVD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1735
Practice Address - Country:US
Practice Address - Phone:270-926-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21960207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
110161621OtherRAILROAD MEDICARE
KY000000045762OtherANTHEM BC/BS
IN200056030OtherMEDICAID
KY64219603Medicaid
110161621OtherRAILROAD MEDICARE
KY1281009Medicare ID - Type Unspecified
KY610890594OtherEIN