Healthcare Provider Details

I. General information

NPI: 1043209000
Provider Name (Legal Business Name): GREGORY MICHAEL BUCHALTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 02/21/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ENT CLINIC - EVANS COMMUNITY HOSPITAL 1650 COCHRANE CIRCLE
FT. CARSON CO
80913
US

IV. Provider business mailing address

1650 COCHRANE CIR
FT CARSON CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-6399
  • Fax: 719-526-7320
Mailing address:
  • Phone: 719-524-6399
  • Fax: 719-503-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number42644
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: