MEDICARE: DR. JOSEPH CARLO BUENDIA D.O.

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	208600000X	Surgery Physician	4726	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134308737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH CARLO BUENDIA D.O.

Provider Business Mailing Address
First Line	:	4140 W MEMORIAL RD STE 621
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8365
Country	:	US
Telephone Number	:	405-749-4231
Fax Number	:	405-749-4234

Provider Business Practice Location Address
First Line	:	4140 W MEMORIAL RD STE 621
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120
Country	:	US
Telephone Number	:	405-749-4231
Fax Number	:	405-749-4234

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

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	05/16/2018

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