Healthcare Provider Details

I. General information

NPI: 1093343014
Provider Name (Legal Business Name): JACK BUCHANAN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE BLDG 5
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

166 GEARY ST STE 1500 #1717
SAN FRANCISCO CA
94108
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8125
  • Fax:
Mailing address:
  • Phone: 415-745-2855
  • Fax: 415-728-9876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA192424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: