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General NPI Number Information
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NPI Number | 1396045639
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Entity Type | Individual
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Provider Name | LEONARD ROBERT PUETT III PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 1148 BROADWAY STE 100
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City | TACOMA
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State | WA
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Zip | 98402-3518
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Country | US
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Telephone | 253-722-2161
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Fax |
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Provider Business Mailing Address
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Address Line | 2420 S UNION AVE STE 300
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City | TACOMA
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State | WA
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Zip | 98405-1387
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Country | US
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Telephone | 253-680-6200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60195245
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License Number State | WA
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