Healthcare Provider Details

I. General information

NPI: 1639738446
Provider Name (Legal Business Name): JORDAN MARIE BUECHE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BAY PINES BLVD
BAY PINES FL
33744-8200
US

IV. Provider business mailing address

4936 MIRAMAR DR UNIT 4211
MADEIRA BEACH FL
33708-3397
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax:
Mailing address:
  • Phone: 941-544-1034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPR605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: