Individual
JASON BUCKALOO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
13800 VETERANS WAY, ORLANDO, FL 32827-7401
(407) 631-0100
Mailing address
13800 VETERANS WAY, ORLANDO, FL 32827-7401
(076) 310-1004
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAT9117647
FL
363AM0700X
Medical Physician Assistant
PA9117647
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124305100
—
FL
01
—
PAT9117647
STATE MEDICAL LICENSE
FL
Enumeration date
02/24/2021
Last updated
11/18/2024
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