Individual
JAMIE L. PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1101 HIGHWAY K, O FALLON, MO 63366-8431
(636) 379-6363
Mailing address
PO BOX 955534 SUITE 100, SAINT LOUIS, MO 63195-0001
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
108740
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
204809008
—
MO
Enumeration date
07/11/2005
Last updated
09/03/2024
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