Healthcare Provider Details

I. General information

NPI: 1013900562
Provider Name (Legal Business Name): MARK EDWARD BUCHANAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SKYLINE DR
RUSSELLVILLE AR
72801-3363
US

IV. Provider business mailing address

101 SKYLINE DR
RUSSELLVILLE AR
72801-3363
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-2345
  • Fax: 479-890-2497
Mailing address:
  • Phone: 479-968-2345
  • Fax: 479-890-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35041
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number42906
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE-10082
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: