Healthcare Provider Details

I. General information

NPI: 1396045639
Provider Name (Legal Business Name): LEONARD ROBERT PUETT III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERT PUETT

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1148 BROADWAY STE 100
TACOMA WA
98402-3518
US

IV. Provider business mailing address

2420 S UNION AVE STE 300
TACOMA WA
98405-1387
US

V. Phone/Fax

Practice location:
  • Phone: 253-722-2161
  • Fax:
Mailing address:
  • Phone: 253-680-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60195245
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: