Individual
LOY C PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1515 UNION AVE, MOBERLY, MO 65270-9407
(660) 269-3157
Mailing address
4108 FALL RIDGE DR, COLUMBIA, MO 65203-6629
(573) 445-3926
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
101050
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101050
LICENSE
MO
01
—
116134
BLUE CROSS/BLUE SHIELD
—
Enumeration date
10/26/2006
Last updated
08/11/2008
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