Individual
MARK ALAN PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2400 EASTPOINT PKWY, SUITE 110, LOUISVILLE, KY 40223-4154
(502) 253-6699
(502) 253-6670
Mailing address
5200 COMMERCE CROSSING, 3RD FLOOR, LOUISVILLE, KY 40229
(502) 253-4924
(502) 489-5750
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
45394
KY
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
45394
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100209760
—
KY
Enumeration date
06/12/2008
Last updated
12/17/2020
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