MEDICARE: DR. SANDRA BUCHANAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME71541	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME71541	OTHER	FL	STATE MEDICAL LICENSE
2	43582	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003923731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA BUCHANAN MD

Provider Business Mailing Address
First Line	:	1185 DUNLAWTON AVE
Second Line	:	SUITE 104
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2905
Country	:	US
Telephone Number	:	386-767-5477
Fax Number	:	386-767-5580

Provider Business Practice Location Address
First Line	:	1185 DUNLAWTON AVE
Second Line	:	SUITE 104
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-2905
Country	:	US
Telephone Number	:	386-767-5477
Fax Number	:	386-767-5580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	02/10/2014

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