Provider Demographics
NPI:1124770789
Name:BUCHANAN, DEAN
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 COMMERCIAL WAY FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1957
Mailing Address - Country:US
Mailing Address - Phone:352-345-0005
Mailing Address - Fax:
Practice Address - Street 1:17038 OTTO LN
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-4909
Practice Address - Country:US
Practice Address - Phone:352-345-0005
Practice Address - Fax:727-868-3053
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009402300Medicaid