Healthcare Provider Details

I. General information

NPI: 1881623395
Provider Name (Legal Business Name): BERNARD J BUCHANAN M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030A BURLEW BLVD
OWENSBORO KY
42303-1735
US

IV. Provider business mailing address

PO BOX 1919
OWENSBORO KY
42302-1919
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-2273
  • Fax:
Mailing address:
  • Phone: 270-926-2273
  • Fax: 270-684-3212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number21960
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21960
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: