1568433308 NPI number — ROBERT A PUIG MD

Table of content: ROBERT A PUIG MD (NPI 1568433308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568433308 NPI number — ROBERT A PUIG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUIG
Provider First Name:
ROBERT
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568433308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7600 SW 87TH AVE
Provider Second Line Business Mailing Address:
STE 206
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33173-3601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-275-5525
Provider Business Mailing Address Fax Number:
305-275-0662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7600 SW 87TH AVE
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33173-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-275-5525
Provider Business Practice Location Address Fax Number:
305-275-0662
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  ME 69739 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7949150 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 281972 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 258869200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 037570 . This is a "NHP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00267805 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 58679 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 011457800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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