# DR. FREDRIC PUCKETT, PLLC

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

## Provider details

- **NPI number:** 1073748562
- **Authorized official:** FREDRIC CLARK PUCKETT DO (PHYSICIAN/OWNER)
- **Authorized official phone:** (972) 875-6200

## Contact information

- **Practice address:** 2203 W LAMPASAS ST STE 111, ENNIS, TX 75119-5667
- **Practice address phone:** (972) 875-6200
- **Practice address fax:** (972) 875-6414
- **Mailing address:** 2203 W LAMPASAS ST STE 111, ENNIS, TX 75119-5667
- **Mailing address phone:** (972) 875-6200
- **Mailing address fax:** (972) 875-6414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 05/27/2009
- **Last updated:** 06/13/2024