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Organization

DR. FREDRIC PUCKETT, PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
FREDRIC CLARK PUCKETT DO (PHYSICIAN/OWNER)
(972) 875-6200
Entity
Organization

Contact information

Practice address
2203 W LAMPASAS ST STE 111, ENNIS, TX 75119-5667
(972) 875-6200
(972) 875-6414
Mailing address
2203 W LAMPASAS ST STE 111, ENNIS, TX 75119-5667
(972) 875-6200
(972) 875-6414

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
208000000X
Pediatrics Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2080303202
TX
Enumeration date
05/27/2009
Last updated
06/13/2024
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