Individual
MARK J PUCCIONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8005 FARNAM DR, SUITE 305, OMAHA, NE 68114
(402) 398-9243
(402) 398-9253
Mailing address
PO BOX 241353, OMAHA, NE 68124
(402) 398-9243
(402) 398-9253
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
21012
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1540658
—
IA
01
—
34166
BCBS
NE
05
—
47061940513
—
NE
01
—
97943
BCBS
IA
Enumeration date
05/12/2006
Last updated
02/13/2008
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