Provider Demographics
NPI:1144858416
Name:BUENO GONZALEZ, DIAN (DO)
Entity type:Individual
Prefix:
First Name:DIAN
Middle Name:
Last Name:BUENO GONZALEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-866-4818
Practice Address - Street 1:1821 BLANDING BLVD STE 1
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-3839
Practice Address - Country:US
Practice Address - Phone:904-406-3160
Practice Address - Fax:833-578-1800
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS22665208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine