Healthcare Provider Details

I. General information

NPI: 1528253952
Provider Name (Legal Business Name): LAURIE BUCCINNA SMALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27348 CASHFORD CIR
WESLEY CHAPEL FL
33544-8198
US

IV. Provider business mailing address

27348 CASHFORD CIR
WESLEY CHAPEL FL
33544-8198
US

V. Phone/Fax

Practice location:
  • Phone: 813-994-7000
  • Fax:
Mailing address:
  • Phone: 813-994-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN11076
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME105403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: