Provider Demographics
NPI:1063491736
Name:PUET, TERRY A (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:A
Last Name:PUET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 PARMALEE AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1605
Mailing Address - Country:US
Mailing Address - Phone:330-539-4319
Mailing Address - Fax:
Practice Address - Street 1:540 PARMALEE AVE STE 310
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1605
Practice Address - Country:US
Practice Address - Phone:330-539-4319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH046335207Q00000X
OH35048335P208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0522465Medicaid
OHA83198Medicare UPIN
OHPU7105471Medicare ID - Type Unspecified