Provider Demographics
NPI:1598741894
Name:PUENTE, FERNANDO R (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:R
Last Name:PUENTE
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 1:800 SPRINGFIELD COMMONS DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8533
Mailing Address - Country:US
Mailing Address - Phone:919-876-3656
Mailing Address - Fax:919-876-2351
Practice Address - Street 1:800 SPRINGFIELD COMMONS DR
Practice Address - Street 2:SUITE 115
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8533
Practice Address - Country:US
Practice Address - Phone:919-876-3656
Practice Address - Fax:919-876-2351
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39984207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA53232Medicare UPIN