Provider Demographics
NPI:1447503255
Name:PUNGER FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:PUNGER FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-466-8884
Mailing Address - Street 1:4640 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34981-5057
Mailing Address - Country:US
Mailing Address - Phone:772-466-8884
Mailing Address - Fax:772-466-8832
Practice Address - Street 1:4640 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-5057
Practice Address - Country:US
Practice Address - Phone:772-466-8884
Practice Address - Fax:772-466-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty