Provider Demographics
NPI:1114184447
Name:PEREZ PUCKLY, LYNELL AURORA (MD)
Entity Type:Individual
Prefix:
First Name:LYNELL
Middle Name:AURORA
Last Name:PEREZ PUCKLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4233
Mailing Address - Country:US
Mailing Address - Phone:281-338-0085
Mailing Address - Fax:281-332-9532
Practice Address - Street 1:450 W MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4234
Practice Address - Country:US
Practice Address - Phone:281-338-0085
Practice Address - Fax:281-332-9532
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN9398207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology