Individual
ROMAN PLATON BUKACHEVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
295 POSADA LN, SUITE B, TEMPLETON, CA 93465-4055
(805) 434-5960
(805) 434-5963
Mailing address
295 POSADA LN, SUITE B, TEMPLETON, CA 93465-4055
(805) 434-5960
(805) 434-5963
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
G71259
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G712591
—
CA
01
—
W15711
MEDICARE GROUP PROVIDER I
CA
Enumeration date
07/22/2005
Last updated
06/29/2010
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