David Johann Puder, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A120199 Issued in CA

Practice address

1790 W Park Ave Ste 200
Redlands, CA 92373-3116

Phone

(909) 334-2608

Fax

(909) 255-9752

NPI assigned

Jun 3, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dpuder10337@direct.llu.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Psychiatry & Psychotherapy PLLC

  • Psychiatry Physician
  • Winter Park, FL
  • NPI 1770222432

  Single Specialty

  NPD Authorized official
• California Holistic Psychiatry Corp

  • Psychiatry Physician
  • Encinitas, CA
  • NPI 1801638838

  Single Specialty

  NPD
• Loma Linda University Medical Center

  • Psychiatric Hospital
  • Redlands, CA
  • NPI 1457000200
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1366762106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 W PARK AVE STE 200",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923733116",
            "telephone_number": "909-334-2608",
            "fax_number": "909-255-9752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 W PARK AVE STE 200",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923733116",
            "telephone_number": "909-334-2608",
            "fax_number": "909-255-9752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUDER",
        "first_name": "DAVID",
        "middle_name": "JOHANN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-03",
        "last_updated": "2023-03-07",
        "certification_date": "2021-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "AC2822890-K10-018",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A120199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY",
            "identifier": "68795",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD OF CALIFORNIA",
            "identifier": "A120199",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Redlands, CA
• Providers in Redlands, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.