Individual
JUSTIN THOMAS PUTHUSSERIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
2776 CLEVELAND AVE, FORT MYERS, FL 33901-5864
(239) 343-2000
Mailing address
6155 42ND STREET CIR E, BRADENTON, FL 34203-7012
(941) 447-7806
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
AA676
FL
Other
Enumeration date
04/29/2021
Last updated
10/05/2021
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