Provider Demographics
NPI:1215510482
Name:BUCHANAN- PEART, KERI-ANN RACQUEL (MD)
Entity type:Individual
Prefix:MRS
First Name:KERI-ANN
Middle Name:RACQUEL
Last Name:BUCHANAN- PEART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERI-ANN
Other - Middle Name:
Other - Last Name:BUCHANAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1611 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-585-5095
Mailing Address - Fax:305-585-8139
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-585-5095
Practice Address - Fax:305-585-8139
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2022-05-31
Deactivation Date:2022-04-26
Deactivation Code:
Reactivation Date:2022-05-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program