MEDICARE: JOSEPH G BUCKNAVAGE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	211119	NY

General Provider Information

NPI Number	:	1124029152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH G BUCKNAVAGE MD

Provider Business Mailing Address
First Line	:	2489 DIPLOMAT PKWY E
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-5422
Country	:	US
Telephone Number	:	239-652-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2489 DIPLOMAT PKWY E
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-5422
Country	:	US
Telephone Number	:	239-652-1800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	08/25/2016

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