Puckett, Andrew Grant

Puckett, Andrew Grant is an individual health care provider with primary practice located at 827 W Wyoming St , Allentown PA 18103-3961. He recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery. Podiatric Medicine & Surgery Service Providers / Podiatrist is his primary health care specialty. Puckett, Andrew Grant can be contacted via phone (610) 432-6221.

Contact Information

Primary practice address
827 W Wyoming St Allentown PA 18103-3961
Phone: (610) 432-6221
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X SC005521 Pennsylvania
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X SC005521 Pennsylvania

Profile Details

NPI number 1174523856
LBN Legal business name Puckett, Andrew Grant
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2005
Last updated Jul 8th, 2007 - about 17 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 1174523856 NPPES
Pennsylvania MEDICAID 0018704060001

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