Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 8250 | MT |
NPI | 1174502017 |
---|---|
Provider Name | Paul Andrew Puckett |
First Address | Missoula, MT 59808-1811 |
Second Address | Missoula, MT 59808-1811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 12/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017051 | (05) | MT |
G28993 | (02) | MT |