Provider Demographics
NPI:1336621069
Name:BUEL, JESSE MICHAEL (CT)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:MICHAEL
Last Name:BUEL
Suffix:
Gender:M
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 37TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-1040
Mailing Address - Country:US
Mailing Address - Phone:843-810-3136
Mailing Address - Fax:
Practice Address - Street 1:1246 37TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-1040
Practice Address - Country:US
Practice Address - Phone:843-810-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTN47079207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology