| NPI | 1629025820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT PUCKETT Authorized Official 904-634-0640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine |
| 207QS0010X Family Medicine, Sports Medicine | |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma | |
| 208VP0000X | |
| 213E00000X Podiatrist | |
| 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery | |
| 174400000X Specialist | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine | |
| 207XS0106X Orthopaedic Surgery, Hand Surgery | |
| 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2026-06-10 |