Puckett, Mark Alan

Puckett, Mark Alan is an individual health care provider with primary practice located at 2400 Eastpoint Pkwy Suite 110, Louisville KY 40223-4154. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Puckett, Mark Alan can be contacted via phone (502) 253-6699.

Contact Information

Primary practice address
2400 Eastpoint Pkwy Suite 110 Louisville KY 40223-4154
Phone: (502) 253-6699
Fax: (502) 253-6670
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 45394 Kentucky
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 45394 Kentucky

Profile Details

NPI number 1649430794
LBN Legal business name Puckett, Mark Alan
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 12th, 2008
Last updated Dec 17th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649430794 NPPES
Kentucky MEDICAID 7100209760

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