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Individual

JOHNNIE L BUCHANAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
11522 OTTERS DEN DR, JACKSONVILLE, FL 32219-5113
(904) 728-8674
Mailing address
11522 OTTERS DEN DR, JACKSONVILLE, FL 32219-5113
(904) 728-8674

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
B255432741870
FL

Other

Enumeration date
12/04/2023
Last updated
12/04/2023
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