Healthcare Provider Details

I. General information

NPI: 1548273295
Provider Name (Legal Business Name): RONALD T BUHAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E COMMERCIAL BLVD SUITE 101
FT LAUDERDALE FL
33308-3737
US

IV. Provider business mailing address

1900 E COMMERCIAL BLVD SUITE 101
FT LAUDERDALE FL
33308-3737
US

V. Phone/Fax

Practice location:
  • Phone: 954-351-5838
  • Fax: 954-351-5836
Mailing address:
  • Phone: 954-351-5838
  • Fax: 954-351-5836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME71133
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: