Individual
JERRY B BUCHANAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
200 ABRAHAM FLEXNER WAY, LOUISVILLE, KY 40202-1818
(502) 583-2731
(502) 583-2733
Mailing address
222 S 1ST ST, SUITE 501, LOUISVILLE, KY 40202-5404
(502) 583-2731
(502) 583-2733
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
14127
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000062493
ANTHEM BLUE FACET
KY
05
—
0160095000
—
WV
05
—
02734476
—
NY
05
—
060793901
—
TX
01
—
100321580
MANAGED HEALTH SERVICES
KY
05
—
100321580
—
IN
05
—
1054568
—
KY
05
—
2126498
—
OH
05
—
64141278
—
KY
05
—
9097732-00
—
FL
05
—
XPY200542
—
CA
Enumeration date
07/20/2006
Last updated
10/15/2010
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