Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 42644 | CO |
NPI | 1043209000 |
---|---|
Provider Name | Dr. Gregory Michael Buchalter |
First Address | Ft Carson, CO 80913-4613 |
Second Address | Colorado Springs, CO 80907-8731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 08/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
65208510 | (05) | CO |
H44921 | (02) | CO |