Healthcare Provider Details

I. General information

NPI: 1053383380
Provider Name (Legal Business Name): BRYAN S. BUCHANAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 819 BOX 18-100
FPO AE
09645
US

IV. Provider business mailing address

PSC 819 BOX 18-100
FPO AE
09645
US

V. Phone/Fax

Practice location:
  • Phone: 01134956823415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number18670
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: