Provider Demographics
NPI:1932196292
Name:PUGLISI, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:PUGLISI
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 1:182 NE 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3412
Mailing Address - Country:US
Mailing Address - Phone:305-653-6500
Mailing Address - Fax:305-651-0701
Practice Address - Street 1:182 NE 168TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3412
Practice Address - Country:US
Practice Address - Phone:305-651-4300
Practice Address - Fax:305-651-0701
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME25860207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065425600Medicaid
FL92224Medicare ID - Type UnspecifiedMEDICARE DADE CO
FLD79523Medicare UPIN
FL92224AMedicare ID - Type UnspecifiedMEDICARE BROWARD CO