Southeast Orthopedic Specialists, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC

Practice address

2001 County Road 210 W Ste 200
Saint Johns, FL 32259-2063

Phone

(904) 634-0640

Fax

(904) 634-0203

NPI assigned

Mar 28, 2018

Last updated

Dec 12, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brett PuckettNPI 1831150960

Title

VP

Phone

(904) 634-0640

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brett Christopher Puckett, MD

  • Orthopaedic Hand Surgery Physician
  • Jacksonville, FL
  • NPI 1831150960
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670803200000",
    "number": "1477058709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 SOUTHPOINT PKWY STE 300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168203",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 COUNTY ROAD 210 W STE 200",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322592063",
            "telephone_number": "904-634-0640",
            "fax_number": "904-634-0203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-28",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-12",
        "status": "A",
        "authorized_official_last_name": "PUCKETT",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "904-634-0640"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sound Mind Counseling and Education Services, Inc.
• Southeast Interventional Pain Specialists, Inc
• Southeast Orthopedic Specialists, Inc
• Southeast Orthopedic Specialists, LLC
• Southeast Orthopedic Specialists, LLC
• Southeast Orthopedic Specialists, LLC
• Southeast Orthopedic Specialists, LLC
• Spame
• Connor Spangenberg
• Speech With Nicole LLC

• Specialist in Saint Johns, FL
• Providers in Saint Johns, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.