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Individual
TIM K PUCKETT
Active
Individual
TIM K PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME93795
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273922400
—
FL
01
—
53106
BLUE CROSS BLUE SHIELD
—
Enumeration date
11/08/2005
Last updated
05/09/2008
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