Healthcare Provider Details

I. General information

NPI: 1144277179
Provider Name (Legal Business Name): JAIME M PUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 27TH ST
PORTSMOUTH OH
45662-2640
US

IV. Provider business mailing address

255 BARKS RD E
MARION OH
43302-6425
US

V. Phone/Fax

Practice location:
  • Phone: 740-356-5000
  • Fax:
Mailing address:
  • Phone: 740-389-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35036311
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: