Provider Demographics
NPI:1982892592
Name:BUCOBO, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN CARLOS
Middle Name:
Last Name:BUCOBO
Suffix:
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:STONY BROOK UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:HEALTH SCIENCE CENTER T17-060
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8173
Mailing Address - Country:US
Mailing Address - Phone:631-444-2119
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:HEALTH SCIENCE CENTER T17-060
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8173
Practice Address - Country:US
Practice Address - Phone:631-444-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257653207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology