Healthcare Provider Details

I. General information

NPI: 1295871283
Provider Name (Legal Business Name): MARK E. BUCHER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CRADDUCK RD
ADA OK
74820-9400
US

IV. Provider business mailing address

9300 COUNTY ROAD 3500
ADA OK
74820-3597
US

V. Phone/Fax

Practice location:
  • Phone: 405-514-4786
  • Fax: 405-758-5354
Mailing address:
  • Phone: 505-862-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0069871
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: