Provider Demographics
NPI:1407395056
Name:PUETT, BRANNON F (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRANNON
Middle Name:F
Last Name:PUETT
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2630 EAST SEVENTH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204
Mailing Address - Country:US
Mailing Address - Phone:704-364-6110
Mailing Address - Fax:704-364-4245
Practice Address - Street 1:2630 EAST SEVENTH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-364-6110
Practice Address - Fax:704-364-4245
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2018-12-21
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Provider Licenses
StateLicense IDTaxonomies
NC0010-06986363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant