Provider Demographics
NPI:1831130806
Name:PUCKETT, CHRISTOPHER ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:PUCKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4370
Mailing Address - Country:US
Mailing Address - Phone:405-372-1775
Mailing Address - Fax:405-372-1802
Practice Address - Street 1:600 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4370
Practice Address - Country:US
Practice Address - Phone:405-372-1775
Practice Address - Fax:405-372-1802
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16170207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology