# SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC

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

## Provider details

- **NPI number:** 1134820103
- **Authorized official:** BRETT PUCKETT (PRESIDENT)
- **Authorized official phone:** (904) 634-0640

## Contact information

- **Practice address:** 216 SOUTHPARK CIR E STE 216, ST AUGUSTINE, FL 32086-5135
- **Practice address phone:** (904) 634-0203
- **Mailing address:** 6800 SOUTHPOINT PKWY STE 300, JACKSONVILLE, FL 32216-8203

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/15/2023
- **Last updated:** 03/15/2023