MEDICARE: MR. CHARLES R PUETT RT(R)(CT)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471C3401X	Computed Tomography Radiologic Technologist	CRT-12765	AZ

General Provider Information

NPI Number	:	1366652232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES R PUETT RT(R)(CT)

Provider Business Mailing Address
First Line	:	3314 TRINITY AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-4932
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4541 S SILVER BEECH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85730-4030
Country	:	US
Telephone Number	:	325-212-1569
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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