Provider Demographics
NPI:1821096264
Name:PUETT, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:PUETT
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 1:1710 S. 17TH ST.
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6442
Mailing Address - Country:US
Mailing Address - Phone:910-762-1182
Mailing Address - Fax:910-332-1111
Practice Address - Street 1:1710 S. 17TH ST.
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6442
Practice Address - Country:US
Practice Address - Phone:910-762-1182
Practice Address - Fax:910-202-2022
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36806207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8969397Medicaid
NCF60342Medicare UPIN
NC8969397Medicaid
2188056Medicare PIN
F60342Medicare UPIN
NC2312411Medicare PIN