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Provider Information for 1235142191


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Mr. JOHN PATRICK BUCHANAN L.I.S.W.


Sex: Male

NPI: 1235142191
Last Updated: 2007-07-08
Certification Date:

Details

NameValue
NPI1235142191
Enumeration Date2006-08-14
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 1901 SOL RIO CT NW
ALBUQUERQUE, NM 87107-3070
United States

Phone: 505-345-3725 | Fax:
 
Primary Practice Address 6729 4TH ST NW
ALBUQUERQUE, NM 87107-6114
United States

Phone: 505-342-4678 | Fax:505-242-4739
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalNMI-3898
No 1041C0700X - Social Worker - ClinicalTNLSW0000004290