Provider Demographics
NPI:1639106602
Name:PUIG, ENRIQUE ZAMORA (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:ZAMORA
Last Name:PUIG
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 1:567 AVENUE K SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4215
Mailing Address - Country:US
Mailing Address - Phone:863-299-1231
Mailing Address - Fax:863-299-1233
Practice Address - Street 1:567 AVENUE K SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4215
Practice Address - Country:US
Practice Address - Phone:863-299-1231
Practice Address - Fax:863-299-1233
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82847207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262535100Medicaid
FLH44194Medicare UPIN
FL262535100Medicaid