Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 80237 | NM |
NPI | 1477679819 |
---|---|
Provider Name | Dr. Stirling M Puck |
First Address | Santa Fe, NM 87505-4519 |
Second Address | Santa Fe, NM 87505-4519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 19/01/2012 |