Healthcare Provider Details

I. General information

NPI: 1124076518
Provider Name (Legal Business Name): DAVID E PUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 1ST AVE NE
CEDAR RAPIDS IA
52402-5431
US

IV. Provider business mailing address

1650 1ST AVE NE
CEDAR RAPIDS IA
52402-5431
US

V. Phone/Fax

Practice location:
  • Phone: 319-362-3937
  • Fax: 319-362-2900
Mailing address:
  • Phone: 319-362-3937
  • Fax: 319-362-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number31231
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: