Provider Demographics
NPI:1447228705
Name:PUE, CHARLES A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:PUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1921 WALDEMERE ST STE 705
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2913
Mailing Address - Country:US
Mailing Address - Phone:941-366-5864
Mailing Address - Fax:941-316-9819
Practice Address - Street 1:1921 WALDEMERE ST STE 705
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2913
Practice Address - Country:US
Practice Address - Phone:941-366-5864
Practice Address - Fax:941-316-9819
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.060661207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103007300Medicaid
FL103007300Medicaid