Provider Demographics
NPI:1821066192
Name:BUENO, REUBEN A JR (MD)
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:A
Last Name:BUENO
Suffix:JR
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 1:3443 DICKERSON PIKE STE G30
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2541
Mailing Address - Country:US
Mailing Address - Phone:615-769-2799
Mailing Address - Fax:615-769-2798
Practice Address - Street 1:3443 DICKERSON PIKE STE G30
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2541
Practice Address - Country:US
Practice Address - Phone:615-769-2799
Practice Address - Fax:615-769-2798
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-114808208200000X, 2082S0099X, 2082S0105X
TN514182082S0099X, 2082S0105X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114808Medicaid
I32916Medicare UPIN
ILK25206Medicare ID - Type Unspecified