Healthcare Provider Details

I. General information

NPI: 1982664330
Provider Name (Legal Business Name): GLAUCO A PUIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W PALM DR
FLORIDA CITY FL
33034-3223
US

IV. Provider business mailing address

6100 BLUE LAGOON DR STE 365
MIAMI FL
33126-7010
US

V. Phone/Fax

Practice location:
  • Phone: 786-279-0764
  • Fax: 305-245-8019
Mailing address:
  • Phone: 786-322-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME91105
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: