Healthcare Provider Details

I. General information

NPI: 1366652232
Provider Name (Legal Business Name): CHARLES R PUETT RT(R)(CT)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4541 S SILVER BEECH AVE
TUCSON AZ
85730-4030
US

IV. Provider business mailing address

3314 TRINITY AVE
SAN ANGELO TX
76904-4932
US

V. Phone/Fax

Practice location:
  • Phone: 325-212-1569
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License NumberCRT-12765
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: