Healthcare Provider Details

I. General information

NPI: 1376750794
Provider Name (Legal Business Name): WILLIAM A BUCHANAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18323 BOTHELL EVERETT HWY SUITE 220
BOTHELL WA
98012-5246
US

IV. Provider business mailing address

18323 BOTHELL EVERETT HWY SUITE 220
BOTHELL WA
98012-5246
US

V. Phone/Fax

Practice location:
  • Phone: 425-806-5750
  • Fax: 425-806-5701
Mailing address:
  • Phone: 425-806-5750
  • Fax: 425-806-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004682
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: