Provider Demographics
NPI:1396871307
Name:ROBERTO E PUENTE DPM PLLC
Entity type:Organization
Organization Name:ROBERTO E PUENTE DPM PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:E
Authorized Official - Last Name:PUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-883-4820
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2821213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65669OtherBCBSFL
DE8265OtherRAILROAD
FL340145600Medicaid
FL65669OtherBCBSFL
FLK9447AMedicare PIN