Provider Demographics
NPI:1952441719
Name:BUENO, JOCELYN D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:D
Last Name:BUENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13142 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7182
Mailing Address - Country:US
Mailing Address - Phone:813-386-8168
Mailing Address - Fax:813-689-2855
Practice Address - Street 1:819 CYPRESS VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6834
Practice Address - Country:US
Practice Address - Phone:813-634-5858
Practice Address - Fax:813-633-1349
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME79527207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258300300Medicaid
FLP00200282OtherRR MEDICARE
FLME79527OtherLICENSE NO
FLME79527OtherLICENSE NO
FL258300300Medicaid