MEDICARE: DR. GREGORY MICHAEL BUCHALTER 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	207Y00000X	Otolaryngology Physician	42644	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043209000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY MICHAEL BUCHALTER MD

Provider Business Mailing Address
First Line	:	1650 COCHRANE CIR
Second Line	:
City	:	FT CARSON
State	:	CO
Zip	:	80913-4613
Country	:	US
Telephone Number	:	719-524-6399
Fax Number	:	719-503-7059

Provider Business Practice Location Address
First Line	:	ENT CLINIC - EVANS COMMUNITY HOSPITAL
Second Line	:	1650 COCHRANE CIRCLE
City	:	FT. CARSON
State	:	CO
Zip	:	80913
Country	:	US
Telephone Number	:	719-524-6399
Fax Number	:	719-526-7320

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	02/21/2025

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