Healthcare Provider Details

I. General information

NPI: 1972704906
Provider Name (Legal Business Name): BRAD P. BUCHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DRIVE MAIL CODE 0039
LA JOLLA CA
92093-0039
US

IV. Provider business mailing address

9500 GILMAN DRIVE MAIL CODE 0039
LA JOLLA CA
92093-0039
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-2669
  • Fax: 858-534-7545
Mailing address:
  • Phone: 858-534-2669
  • Fax: 858-534-7545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberG69458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: