Healthcare Provider Details

I. General information

NPI: 1629120373
Provider Name (Legal Business Name): PAUL W. BUZA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 W. HIBISCUS BLVD. BREVARD REGIONAL HYPERBARIC CENTER
MELBOURNE FL
32901
US

IV. Provider business mailing address

P.O. BOX 2227
MELBOURNE FL
32902
US

V. Phone/Fax

Practice location:
  • Phone: 321-676-3200
  • Fax: 321-327-2893
Mailing address:
  • Phone: 321-676-3200
  • Fax: 321-327-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberOS6304
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberOS6304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: