Healthcare Provider Details

I. General information

NPI: 1023740404
Provider Name (Legal Business Name): JAMMAL ALEXANDER MARCANO BURET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 BOBCAT VILLAGE CENTER RD UNIT 202
NORTH PORT FL
34288-8999
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-257-2930
  • Fax: 941-257-2923
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME171480
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: