Healthcare Provider Details

I. General information

NPI: 1568728343
Provider Name (Legal Business Name): ENRIQUE OCTAVIO BUJANDA-MORUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 DON WICKHAM DR STE 115
CLERMONT FL
34711-1977
US

IV. Provider business mailing address

1920 DON WICKHAM DR STE 115
CLERMONT FL
34711-1977
US

V. Phone/Fax

Practice location:
  • Phone: 352-323-9530
  • Fax: 321-842-8290
Mailing address:
  • Phone: 352-323-9530
  • Fax: 321-842-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD22263
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME170482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: