Basic Information
| Provider Information | |||||||||
| NPI: | 1710162227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCHANAN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | MAURICE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 N 100 W | ||||||||
| Address2: | SUITE N104 | ||||||||
| City: | VERNAL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840782049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357818464 | ||||||||
| FaxNumber: | 4357818466 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 N 1900 E | ||||||||
| Address2: | #3R210 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841320002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015856387 | ||||||||
| FaxNumber: | 8015814192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2008 | ||||||||
| LastUpdateDate: | 01/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 68051411205 | UT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.