Provider Demographics
NPI:1639248925
Name:BUENASEDA, JOSE ORNUM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ORNUM
Last Name:BUENASEDA
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 1:4005 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8058
Mailing Address - Country:US
Mailing Address - Phone:910-848-5437
Mailing Address - Fax:910-848-5439
Practice Address - Street 1:4005 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-8058
Practice Address - Country:US
Practice Address - Phone:910-848-5437
Practice Address - Fax:910-848-5439
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200601287208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905278Medicaid