Individual
JASON SCOTT PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4100 LAKE DR SE STE 205, GRAND RAPIDS, MI 49546-8292
(616) 267-7414
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
4301111232
MI
Other
Enumeration date
06/16/2011
Last updated
08/03/2021
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