Individual
PAUL LAVAL PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
4215 JOE RAMSEY BLVD, GREENVILLE, TX 75403
(903) 408-5000
(214) 712-2487
Mailing address
2464 FM 2820, SUMMER, TX 75486
(903) 784-1291
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA02778
TX
Other
Enumeration date
08/20/2006
Last updated
06/12/2024
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