# SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC

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

## Provider details

- **NPI number:** 1730500489
- **Authorized official:** BRETT PUCKETT (VP)
- **Authorized official phone:** (904) 634-0640

## Contact information

- **Practice address:** 2300 PARK AVE, SUITE 203, ORANGE PARK, FL 32073-5571
- **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) 674-6155

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | — | FL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/26/2013
- **Last updated:** 12/12/2022