Healthcare Provider Details

I. General information

NPI: 1144475328
Provider Name (Legal Business Name): CARRIE MARGARET PUCKETT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 RIVERBEND DRIVE OREGON HEART AND VASCULAR INSTITUTE
SPRINGFIELD OR
97477
US

IV. Provider business mailing address

1115 SE 164TH AVE DEPARTMENT 358
VANCOUVER WA
98683
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-4332
  • Fax: 541-242-6770
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberDO155470
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: