Provider Demographics
NPI:1881731214
Name:BUENO, MARCO AURELIO (MD)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:AURELIO
Last Name:BUENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARCO
Other - Middle Name:AURELIO
Other - Last Name:BUENO PALACIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17445 SANDGATE CT
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7860
Mailing Address - Country:US
Mailing Address - Phone:813-920-7452
Mailing Address - Fax:813-926-7134
Practice Address - Street 1:17445 SANDGATE CT
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7860
Practice Address - Country:US
Practice Address - Phone:813-920-7452
Practice Address - Fax:813-926-7134
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0414082084P0800X
FLME724932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry