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General NPI Number Information
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NPI Number | 1235377268
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Entity Type | Organization
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Legal Business Name | BEVERLY A. PUCKA, MD P.C.
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Dates
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Enumeration Date | 01/29/2009
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Last Update Date | 01/29/2009
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Provider Practice Location Address
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Address Line | 8120 CONSTITUTION PL NE SUITE 220
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7654
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Country | US
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Telephone | 505-842-8741
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Fax | 505-842-8190
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Provider Business Mailing Address
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Address Line | 8120 CONSTITUTION PL NE SUITE 220
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7654
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Country | US
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Telephone | 505-842-8741
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Fax | 505-842-8190
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Authorized Official
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Title or Position | OWNER
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Name | BEVERLY A PUCKA
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Credential | M.D.
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Telephone | 505-842-8741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 86-107
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License Number State | NM
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