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General NPI Number Information
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NPI Number | 1093343014
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Entity Type | Individual
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Provider Name | JACK BUCHANAN MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 1001 POTRERO AVE BLDG 5
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-3518
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Country | US
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Telephone | 628-206-8125
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Fax |
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Provider Business Mailing Address
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Address Line | 166 GEARY ST STE 1500 #1717
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City | SAN FRANCISCO
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State | CA
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Zip | 94108
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Country | US
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Telephone | 415-745-2855
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Fax | 415-728-9876
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A192424
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License Number State | CA
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