Provider Demographics
NPI:1720240211
Name:BUCHANAN, J. MATTHEW S (DO)
Entity type:Individual
Prefix:DR
First Name:J. MATTHEW
Middle Name:S
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:J. MATTHEW
Other - Middle Name:S
Other - Last Name:BUCHANAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-436-7142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015464207P00000X
COCO49913207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80229042Medicaid
CO024792OtherKAISER COMMERCIAL NUMBER
COP01109045OtherRAILROAD MEDICARE
COP01109045OtherRAILROAD MEDICARE
CO370199YK5YMedicare PIN