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Organization
SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC
Active
Organization
SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC
Active
Parent organization
SOUTHEAST ORTHOPEDIC SPECIALISTS, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHEAST ORTHOPEDIC SPECIALISTS, INC.
Authorized official
BRETT PUCKETT MD (MD)
(904) 634-0640
Entity
Organization
Contact information
Practice address
1690 US HIGHWAY 1 S, ST AUGUSTINE, FL 32084-4192
(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
03/31/2023
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