Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME111277 | FL |
Y | 2080A0000X | Adolescent Medicine | ME111277 | FL |
NPI | 1053353037 |
---|---|
Provider Name | Dr. Jospeh Anthony Puccio |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33620-6750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 28/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004251600 | (05) | FL |
14HQ1 | BLUE CROSS BLUE SHIELD (01) | FL |