Provider Demographics
NPI:1851398994
Name:PUNGER, DENISE LYNNE (MD)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:LYNNE
Last Name:PUNGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34981-5057
Mailing Address - Country:US
Mailing Address - Phone:772-466-8884
Mailing Address - Fax:772-466-8832
Practice Address - Street 1:4640 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-5057
Practice Address - Country:US
Practice Address - Phone:772-466-8884
Practice Address - Fax:772-466-8832
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378728100Medicaid
FLF72698Medicare UPIN
FL27389SMedicare ID - Type Unspecified