Provider Demographics
NPI:1568728343
Name:BUJANDA-MORUN, ENRIQUE OCTAVIO (MD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:OCTAVIO
Last Name:BUJANDA-MORUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 DON WICKHAM DR STE 115
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1977
Mailing Address - Country:US
Mailing Address - Phone:352-323-9530
Mailing Address - Fax:321-842-8290
Practice Address - Street 1:1920 DON WICKHAM DR STE 115
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1977
Practice Address - Country:US
Practice Address - Phone:352-323-9530
Practice Address - Fax:321-842-8290
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-06
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD22263208600000X
FLME170482208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124065300Medicaid