Individual
DR. JUSTIN DAVID PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2004 N BALTIMORE ST STE A, KIRKSVILLE, MO 63501-5107
(660) 665-7575
(660) 665-7576
Mailing address
PO BOX 551, HANNIBAL, MO 63401-0551
(660) 665-7575
(660) 665-7576
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2006017939
MO
207Q00000X
Family Medicine Physician
Primary
2007018127
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209398502
—
MO
01
—
MA1807001
MEDICARE
MO
Enumeration date
05/21/2007
Last updated
09/26/2018
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