# JOHN W PUCKETT MD FACS INC

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

## Provider details

- **NPI number:** 1841419454
- **Authorized official:** DR. JOHN WILLIS PUCKETT MD (VASCULAR SURGEON)
- **Authorized official phone:** (949) 574-7176

## Contact information

- **Practice address:** 520 SUPERIOR AVE., \#370, NEWPORT BEACH, CA 92663-3623
- **Practice address phone:** (949) 574-7176
- **Practice address fax:** (979) 574-7180
- **Mailing address:** 520 SUPERIOR AVE, \#370, NEWPORT BEACH, CA 92663-3637
- **Mailing address phone:** (949) 574-7176
- **Mailing address fax:** (979) 574-7180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | G38172A | CA | Yes |

## Other

- **Enumeration date:** 04/24/2007
- **Last updated:** 02/03/2014