Provider Demographics
NPI:1750524427
Name:PUK, GERALD (PHD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:PUK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MIDDLEFIELD RD # 208
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2124
Mailing Address - Country:US
Mailing Address - Phone:650-328-5821
Mailing Address - Fax:650-508-9099
Practice Address - Street 1:555 MIDDLEFIELD RD # 208
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2124
Practice Address - Country:US
Practice Address - Phone:650-328-5821
Practice Address - Fax:650-508-9099
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10704103TC0700X
NY006074-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical