Healthcare Provider Details

I. General information

NPI: 1124051115
Provider Name (Legal Business Name): HERON SPRINGS FAMILY MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8425 BALM ST
WEEKI WACHEE FL
34607-4419
US

IV. Provider business mailing address

8425 BALM ST
WEEKI WACHEE FL
34607-4419
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-1770
  • Fax: 352-596-1553
Mailing address:
  • Phone: 352-596-1770
  • Fax: 352-596-1553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VINCENT TODD BUCKMAN
Title or Position: OWNER PARTNER
Credential: MD
Phone: 352-596-1770