Healthcare Provider Details

I. General information

NPI: 1467662957
Provider Name (Legal Business Name): MR. WILLIAM REX BUZZETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 CECIL G COSTIN BLVD
PORT ST JOE FL
32456
US

IV. Provider business mailing address

101 20TH ST
PORT ST JOE FL
32456
US

V. Phone/Fax

Practice location:
  • Phone: 850-227-7099
  • Fax:
Mailing address:
  • Phone: 850-227-1753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13445
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: