Active NPI
Robert D. Puder, M.D.
- Psychiatry Physician
- Jacksonville, NC
National Provider Identifier
1639512833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- E4613
- Practice address
- 1250 Western Blvd Ste L2
#292
Jacksonville, NC 28546-6755 - Phone
- (910) 378-0672
- NPI assigned
- Apr 8, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | E4613 | TX | Primary |
| Psychiatry Physician | 2084P0800X | 0101042811 | VA | |
| Psychiatry Physician | 2084P0800X | 168564 | NY |
Addresses
Primary practice location
1250 Western Blvd Ste L2
#292
Jacksonville, NC 28546-6755
Mailing address
1250 Western Blvd Ste L2
#292
Jacksonville, NC 28546-6755
Phone (910) 378-0672
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 168564 | NY | MD | Psychiatry Physician |
| E4613 | TX | MD | Psychiatry Physician |
| 0101042811 | VA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365379200000",
"number": "1639512833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1250 WESTERN BLVD STE L2",
"address_2": "#292",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285466755",
"telephone_number": "910-378-0672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 WESTERN BLVD STE L2",
"address_2": "#292",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285466755",
"telephone_number": "910-378-0672"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUDER",
"first_name": "ROBERT",
"middle_name": "D.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-04-08",
"last_updated": "2013-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TX",
"license": "E4613",
"primary": true
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "VA",
"license": "0101042811",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "168564",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, NC
- Primecare Physicians of Jacksonville, PLLC
- Cynthia Lee Probasco, RN
- Jakob Probst, PA-C
- Professional Physical Therapy & Rehabilitation, LLC
- Publix North Carolina, LP (Publix Pharmacy #1660)
- Lisa Pugh, LMBT 7027
- Pulse Transport and Logistics LLC
- Arun Pyakuryal, MD
- Qeh Transport LLC (StellarMed Mobile Transport)
- Haley Quaranta
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.