Provider Demographics
NPI:1306223680
Name:PUNT, CASSIDY LAWRENCE
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:LAWRENCE
Last Name:PUNT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 GOLDEN RIDGE RD
Mailing Address - Street 2:STE 250
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-9541
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:660 GOLDEN RIDGE RD STE 250
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-9541
Practice Address - Country:US
Practice Address - Phone:303-233-1223
Practice Address - Fax:303-233-8755
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11908363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant