1992758494 NPI number — DR. JAMES BUFORD MADISON III MD

Table of content: DR. JAMES BUFORD MADISON III MD (NPI 1992758494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992758494 NPI number — DR. JAMES BUFORD MADISON III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MADISON
Provider First Name:
JAMES
Provider Middle Name:
BUFORD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992758494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8000 RED BUG LAKE RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765-9226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-366-7411
Provider Business Mailing Address Fax Number:
407-366-7385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 RED BUG LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-9226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-366-7411
Provider Business Practice Location Address Fax Number:
407-366-7385
Provider Enumeration Date:
05/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  ME8729 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 48484 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00226279 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".