Provider Demographics
NPI:1215930219
Name:BUCHERT, GREGORY SCOTT (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:BUCHERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W LA VETA AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4231
Mailing Address - Country:US
Mailing Address - Phone:714-246-8688
Mailing Address - Fax:714-481-6427
Practice Address - Street 1:1120 W LA VETA AVE
Practice Address - Street 2:FL 2
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4231
Practice Address - Country:US
Practice Address - Phone:714-246-8688
Practice Address - Fax:714-481-6427
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41851208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine