Organization
PUCKETT FAMILY CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL LAVAL PUCKETT PA-C (PHYSICIAN ASSISTANT - CERTIFIED)
(903) 378-3444
Entity
Organization
Contact information
Practice address
1301 E MAIN ST, HONEY GROVE, TX 75446-1268
(903) 378-3444
Mailing address
PO BOX 166, HONEY GROVE, TX 75446-0166
(903) 378-3444
(903) 378-3445
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
PA02778
TX
363AM0700X
Medical Physician Assistant
PA02778
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA02778
STATE LICENSE
TX
Enumeration date
06/01/2007
Last updated
10/25/2012
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