Provider Demographics
NPI:1710013818
Name:PUENTE, ROBERTO ENRIQUE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:ENRIQUE
Last Name:PUENTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21300 GERTRUDE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5002
Mailing Address - Country:US
Mailing Address - Phone:941-883-4820
Mailing Address - Fax:941-883-6086
Practice Address - Street 1:21300 GERTRUDE AVE STE 3
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5002
Practice Address - Country:US
Practice Address - Phone:941-883-4820
Practice Address - Fax:941-883-6086
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2821213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65669OtherBCBSFL
P00318348OtherRAILROAD
FL340145600Medicaid
FL340145600Medicaid
E4087XMedicare PIN
P00318348OtherRAILROAD