Puckett, Jerry Hanson
Puckett, Jerry Hanson is an individual health care provider with primary practice located at 6475 S Yale Ave Ste 401 , Tulsa OK 74136-7818. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Puckett, Jerry Hanson can be contacted via phone (918) 502-9555.Contact Information
Primary practice address
6475 S Yale Ave Ste 401
Tulsa OK 74136-7818
Phone: (918) 502-9555
Fax: (918) 502-9559
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | 12175 | Oklahoma |
Profile Details
| NPI number | 1366441115 |
|---|---|
| LBN Legal business name | Puckett, Jerry Hanson |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 14th, 2005 |
| Last updated | Apr 13th, 2018 - about 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366441115 | NPPES |
| Oklahoma | MEDICAID | 100078700A |
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