Provider Demographics
NPI:1063403962
Name:BUCHMAN, MARK T (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:BUCHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:T
Other - Last Name:BUCHMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:ATTEN CHRISTIE MSS
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7350
Mailing Address - Country:US
Mailing Address - Phone:308-865-2500
Mailing Address - Fax:308-865-2511
Practice Address - Street 1:2479 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-3204
Practice Address - Country:US
Practice Address - Phone:605-644-4460
Practice Address - Fax:605-644-4461
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22803207XS0106X
NE16423207XS0106X
KS04-32877207XS0106X
SD9188207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00056OtherBCBS
253620OtherMIDLANDS CHOICE
P00396968OtherRAILROAD MEDICARE
E38197Medicare UPIN
NE00056OtherBCBS