| Organization Name: | DR. FREDRIC PUCKETT, PLLC |
| NPI Number: | 1073748562 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FREDRIC CLARK PUCKETT (SOLE MEMBER) |
| Mailing Address: | 2203 W Lampasas St Suite 101 Ennis |
| State: | TX US |
| Postal Code: | 751195644 |
| Phone Number: | 9728757799 |
| Fax Number: | 9728783031 |
| NPI Enumeration Date: | 05/27/2009 |
| NPI Last Update Date: | 05/27/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | N1080 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |