Individual
ALBERT PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPRS
Contact information
Practice address
282 STELTON RD, XENIA, OH 45385-5220
(937) 708-8348
Mailing address
PO BOX 212, XENIA, OH 45385-0212
(517) 242-4107
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
APS.004401
OH
Other
Enumeration date
10/12/2023
Last updated
10/12/2023
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