Individual
DR. JOHN ANTHONY BUONOCORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3005 E STATE BLVD, FORT WAYNE, IN 46805-4736
(260) 267-9498
Mailing address
3005 E STATE BLVD, FORT WAYNE, IN 46805-4736
(260) 267-9498
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
182693
NY
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
02004457A
IN
208VP0014X
Interventional Pain Medicine Physician
182693
NY
208VP0014X
Interventional Pain Medicine Physician
3411255
OH
208VP0014X
Interventional Pain Medicine Physician
5101020847
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0103569
—
OH
05
—
1992801492
—
MI
Enumeration date
09/15/2006
Last updated
04/01/2024
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