Individual
MR. MARCUS CLEO BUCHANAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 E DOWNING ST, TAHLEQUAH, OK 74464-3324
(918) 456-0641
Mailing address
PO BOX 864, CHOUTEAU, OK 74337-0864
(918) 864-4665
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
—
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
OK
Enumeration date
03/30/2022
Last updated
03/30/2022
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