Healthcare Provider Details

I. General information

NPI: 1881030450
Provider Name (Legal Business Name): THADDEUS JOSEPH PUZIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TEDDY PUZIO MD

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6414 FANNIN ST STE G150
HOUSTON TX
77030-1514
US

IV. Provider business mailing address

13911 MULBERRY RIVER LN
HOUSTON TX
77059-2521
US

V. Phone/Fax

Practice location:
  • Phone: 832-325-7125
  • Fax:
Mailing address:
  • Phone: 540-537-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberS0064
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: