Provider Demographics
NPI:1649332040
Name:BUFFONE, GARY WARREN (PHD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:WARREN
Last Name:BUFFONE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 MANGO PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3325
Mailing Address - Country:US
Mailing Address - Phone:904-346-0044
Mailing Address - Fax:904-346-0288
Practice Address - Street 1:2149 MANGO PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3325
Practice Address - Country:US
Practice Address - Phone:904-346-0044
Practice Address - Fax:904-346-0288
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLPY002086103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist