Organization
SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT N PUCKETT (PHYSICIAN/AUTHORIZED)
(904) 349-0290
Entity
Organization
Contact information
Practice address
10475 CENTURION PKWY N STE 220, JACKSONVILLE, FL 32256-5004
(904) 634-0640
(904) 674-6155
Mailing address
6800 SOUTHPOINT PKWY STE 300, JACKSONVILLE, FL 32216-8203
(904) 634-0640
(904) 674-6155
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74895
BCBS
FL
Enumeration date
12/26/2013
Last updated
12/12/2022
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