Healthcare Provider Details

I. General information

NPI: 1821096264
Provider Name (Legal Business Name): DAVID W PUETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 S. 17TH ST.
WILMINGTON NC
28401-6442
US

IV. Provider business mailing address

1710 S. 17TH ST.
WILMINGTON NC
28401-6442
US

V. Phone/Fax

Practice location:
  • Phone: 910-762-1182
  • Fax: 910-202-2022
Mailing address:
  • Phone: 910-762-1182
  • Fax: 910-332-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number36806
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: