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1609857549 NPI number — TIM K PUCKETT MD

NPI Number: 1609857549
Health Care Provider/Practitioner: TIM K PUCKETT MD

Information about “1609857549” NPI (TIM K PUCKETT MD) exists in 1609857549 in HTML format HTML  |  1609857549 in plain Text format TXT  |  1609857549 in PDF (Portable Document Format) PDF  |  1609857549 in an XML format XML  formats.

NPI Number : 1609857549 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609857549",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PUCKETT",
    "FirstName": "TIM",
    "MiddleName": "K",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8110 ROYAL PALM BLVD",
    "SecondLineMailingAddress": "STE 108",
    "MailingAddressCityName": "CORAL SPRINGS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33065-5795",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-341-8288",
    "MailingAddressFaxNumber": "954-341-5156",
    "FirstLinePracticeLocationAddress": "8110 ROYAL PALM BLVD",
    "SecondLinePracticeLocationAddress": "STE 108",
    "PracticeLocationAddressCityName": "CORAL SPRINGS",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33065-5795",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-341-8288",
    "PracticeLocationAddressFaxNumber": "954-341-5156",
    "EnumerationDate": "11/08/2005",
    "LastUpdateDate": "05/09/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207V00000X",
        "TaxonomyName": "Obstetrics & Gynecology Physician",
        "LicenseNumber": "ME93795",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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