Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 4587 | WI |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D10480 | MN |
NPI | 1073663449 |
---|---|
Provider Name | Duncan R Puffer |
First Address | Duluth, MN 55811-4046 |
Second Address | Duluth, MN 55811-4046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 29/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
143022000 | (05) | MN |
33720200 | WISCONSIN MEDICAID (01) | WI |
6B745PU | MINNESOTA BCBS (01) | MN |
U02059 | (02) | MN |