Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 34008701 | OH |
NPI | 1144209156 |
---|---|
Provider Name | Dr. Dennis J. Buono |
First Address | Port Clinton, OH 43452-2607 |
Second Address | Port Clinton, OH 43452-2607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 04/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2634466 | (05) | OH |
BB8303543 | DEA (01) | MI |
H99014 | (02) | OH |