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Organization
SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC
Active
Organization
SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT PUCKETT MD (MD)
(904) 634-0640
Entity
Organization
Contact information
Practice address
3055 COUNTY ROAD 210 W STE 110, ST JOHNS, FL 32259-7001
(904) 634-0640
(904) 634-0203
Mailing address
6800 SOUTHPOINT PKWY STE 300, JACKSONVILLE, FL 32216-8203
(904) 634-0640
(904) 634-0203
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NULL
332BC3200X
Customized Equipment (DME)
—
NULL
335E00000X
Prosthetic/Orthotic Supplier
—
NULL
Other
Enumeration date
07/28/2022
Last updated
03/08/2023
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