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Individual

TEDD R PUCKETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
106 S FRANKLIN ST STE C, CHRISTIANSBURG, VA 24073-3547
(540) 381-2013
Mailing address
106 S FRANKLIN ST STE C, CHRISTIANSBURG, VA 24073-3547
(540) 381-2013

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101058838
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
006303200
VA
05
006303293
VA
01
0193226
GIGNA
VA
01
0800644
UNITED HEALTHCARE
VA
01
258585
ANTHEM (BLUE CROSS)
VT
01
452768
ANTHEM (BLUE CROSS)
VA
01
5978709
AETNA
VA
Enumeration date
11/08/2006
Last updated
04/29/2015
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