Mark Alan Puckett

NPI 1649430794 - Family Medicine - 207Q00000X

NPI Details
NPI 1649430794
Gender Male
Enumeration Date 06/12/2008
Last Updated 03/03/2016
Entity Type Individual
Active Over 8 years ago
Practice Location
2400 EASTPOINT PKWY
SUITE 110
LOUISVILLE KY, 40223-4154, US
Phone (502) 253-6699
Fax (502) 253-6670
Business Location
PO BOX 950248
LOUISVILLE KY, 40295-0248, US
Phone (502) 253-1035
Fax (502) 253-1037
Toxanomy
Taxonomy Code 207Q00000X
License State Kentucky
License Number 45394
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According to our database, Mark Alan Puckett NPI is 1649430794, taxonomy code is 207Q00000X and license number is 45394, license state is located at Kentucky. Mark Alan Puckett physically located at 2400 Eastpoint Pkwy, Louisville KY, 40223-4154. NPI Number Mark Alan Puckett has the Individual type.

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1649430794 NPI number is provided on an as is basis without warranty of any kind. 1649430794 is maintained by the National Plan & Provider Enumeration System. The contents of Mark Alan Puckett are for informational purposes only.