Healthcare Provider Details

I. General information

NPI: 1023185261
Provider Name (Legal Business Name): WILLIAM L BUCHANAN M.D., D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6012 W WILLIAM CANNON DR B101
AUSTIN TX
78749-1980
US

IV. Provider business mailing address

PO BOX 979
TAYLOR TX
76574-0979
US

V. Phone/Fax

Practice location:
  • Phone: 512-346-8830
  • Fax: 512-472-5713
Mailing address:
  • Phone: 512-346-8830
  • Fax: 512-472-5713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberF5162
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number9189
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: