Individual
DR. TERRY LEE PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.P.H.
Contact information
Practice address
24530 FALCON PLACE BLVD STE 100, ABINGDON, VA 24211-7665
(276) 619-0075
(276) 619-0077
Mailing address
603 CAMPUS DR, SUITE 100, ABINGDON, VA 24210-9700
(276) 739-8010
(276) 628-1410
Taxonomy
Speciality
Code
Description
License number
State
2083A0100X
Aerospace Medicine Physician
Primary
0101241208
VA
2083A0100X
Aerospace Medicine Physician
MD 18289
TN
2083X0100X
Occupational Medicine Physician
MD 18289
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376510222
—
VA
01
—
P01599940
RR MEDICARE
VA
05
—
Q000141
—
TN
Enumeration date
02/28/2006
Last updated
06/05/2018
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