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General NPI Number Information
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NPI Number | 1215688122
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Entity Type | Individual
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Provider Name | JAKE BUFFONE RD
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Gender | Male
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 4800 S SAGINAW ST
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City | FLINT
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State | MI
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Zip | 48507-2677
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Country | US
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Telephone | 810-732-8336
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Fax |
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Provider Business Mailing Address
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Address Line | 642 GRUBER ST APT B5
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City | FRANKENMUTH
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State | MI
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Zip | 48734-1033
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Country | US
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Telephone | 248-421-2666
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State | MI
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