# SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003542465
- **Authorized official:** BRETT PUCKETT MD (MD)
- **Authorized official phone:** (904) 634-0640

## Contact information

- **Practice address:** 3055 COUNTY ROAD 210 W STE 110, ST JOHNS, FL 32259-7001
- **Practice address phone:** (904) 634-0640
- **Practice address fax:** (904) 634-0203
- **Mailing address:** 6800 SOUTHPOINT PKWY STE 300, JACKSONVILLE, FL 32216-8203
- **Mailing address phone:** (904) 634-0640
- **Mailing address fax:** (904) 634-0203

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | — |

## Other

- **Enumeration date:** 07/28/2022
- **Last updated:** 03/08/2023