1710048335 NPI number — MR. DEREK JAMES BUCHANAN

Table of content: MR. UCHE HENRY ISIOCHA MD (NPI 1942204433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710048335 NPI number — MR. DEREK JAMES BUCHANAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCHANAN
Provider First Name:
DEREK
Provider Middle Name:
JAMES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710048335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 SW TAYLOR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97205-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-228-2154
Provider Business Mailing Address Fax Number:
503-228-4694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 SW TAYLOR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97205-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-228-2154
Provider Business Practice Location Address Fax Number:
503-228-4694
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  NOT APPLICABLE , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 156FX1800X , with the licence number: NOT APPLICABLE , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 838474000 . This is a "REGENCE BCBS PROVIDER #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: TIN CONFIDENTIAL . This is a "LIFEWISE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 049424 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1931129593 . This is a "VOCATIONAL REHAB VENDOR #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: TIN CONFIDENTIAL . This is a "SUPERIOR VISION" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 278184 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: J6344 . This is a "PACIFIC SOURCE PROVIDER #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: OP1880 . This is a "EYEMED PROVIDER #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: TIN CONFIDENTIAL . This is a "CARE OREGON PROVIDER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: TIN CONFIDENTIAL . This is a "MESO" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: TIN CONFIDENTIAL . This is a "ODS HEALTH PLAN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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