John W Puckett MD Facs Inc

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

G38172A Issued in CA

Legal business name

JOHN W PUCKETT MD FACS INC

Practice address

520 Superior Ave.
#370
Newport Beach, CA 92663-3623

Phone

(949) 574-7176

Fax

(979) 574-7180

NPI assigned

Apr 24, 2007

Last updated

Feb 3, 2014By 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

Dr. John Willis Puckett, MD

Title

Vascular Surgeon

Phone

(949) 574-7176

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391385600000",
    "number": "1841419454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 SUPERIOR AVE",
            "address_2": "#370",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633637",
            "telephone_number": "949-574-7176",
            "fax_number": "979-574-7180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 SUPERIOR AVE.",
            "address_2": "#370",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633623",
            "telephone_number": "949-574-7176",
            "fax_number": "979-574-7180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN W PUCKETT MD FACS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2014-02-03",
        "status": "A",
        "authorized_official_last_name": "PUCKETT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WILLIS",
        "authorized_official_title_or_position": "VASCULAR SURGEON",
        "authorized_official_telephone_number": "949-574-7176",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "G38172A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• John Paul Micha M D a Professional Corporation
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• Martin Eugene Johns
• Abigail D Johnson, P.T.
• Amanda Bella Johnson
• Amber Johnson, MD

• Vascular Surgery Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Vascular Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; 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.