Provider Demographics
NPI:1194749002
Name:BUZZELLA, ERIN RAND (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:RAND
Last Name:BUZZELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EVELYN
Other - Middle Name:ERIN
Other - Last Name:RAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 100371
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0371
Mailing Address - Country:US
Mailing Address - Phone:352-338-2195
Mailing Address - Fax:352-265-0627
Practice Address - Street 1:1100 11TH ST SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3608
Practice Address - Country:US
Practice Address - Phone:386-362-1413
Practice Address - Fax:386-364-4503
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69125207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G34664Medicare UPIN
FL31646YMedicare ID - Type Unspecified