Healthcare Provider Details

I. General information

NPI: 1801185897
Provider Name (Legal Business Name): MATTHEW P BUZZEO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 CRYSTAL GROVE DR
LAKELAND FL
33801-6875
US

IV. Provider business mailing address

2125 CRYSTAL GROVE DR
LAKELAND FL
33801-6875
US

V. Phone/Fax

Practice location:
  • Phone: 863-688-2334
  • Fax:
Mailing address:
  • Phone: 863-688-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME130765
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: