Individual
KELLY D PUCEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24 PHYSICIANS DR, JACKSON, TN 38305-2070
(731) 661-9825
(731) 668-6757
Mailing address
24 PHYSICIANS DR, JACKSON, TN 38305-2070
(731) 661-9825
(731) 668-6757
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD30606
TN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD30606
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q010037
—
TN
Enumeration date
09/21/2006
Last updated
11/02/2015
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