Basic Information
| Provider Information | |||||||||
| NPI: | 1881623395 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCHANAN | ||||||||
| FirstName: | BERNARD | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1919 | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423021919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709262273 | ||||||||
| FaxNumber: | 2706843212 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030A BURLEW BLVD | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709262273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 03/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 21960 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207R00000X | 21960 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110161621 | 01 | RAILROAD MEDICARE | OTHER | 000000045762 | 01 | KY | ANTHEM BC/BS | OTHER | 200056030 | 01 | IN | MEDICAID | OTHER | 64219603 | 05 | KY | MEDICAID |