MEDICARE: DR. JOSE DAVID PUELL MD

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	207Q00000X	Family Medicine Physician	ME111013	FL
2	208000000X	Pediatrics Physician	ME111013	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2-1547	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376519553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE DAVID PUELL MD

Provider Business Mailing Address
First Line	:	1454 MADISON AVE W
Second Line	:
City	:	IMMOKALEE
State	:	FL
Zip	:	34142-2200
Country	:	US
Telephone Number	:	239-658-3064
Fax Number	:	239-658-3175

Provider Business Practice Location Address
First Line	:	6350 DAVIS BLVD # 1001
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-5323
Country	:	US
Telephone Number	:	239-658-3000
Fax Number	:

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	04/26/2023

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