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General NPI Number Information
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NPI Number | 1558894683
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Entity Type | Individual
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Provider Name | LAURA PUCKETT MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 3000 NE 2ND AVE APT 617
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City | MIAMI
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State | FL
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Zip | 33137-5406
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Country | US
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Telephone | 281-682-1363
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Fax |
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Provider Business Mailing Address
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Address Line | 5525 N STANTON ST APT 29G
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City | EL PASO
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State | TX
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Zip | 79912-6408
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Country | US
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Telephone | 281-682-1363
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME150404
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License Number State | FL
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