Provider Demographics
NPI:1831199421
Name:PUCKETT, SARAH S (DO)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:S
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-824-1444
Mailing Address - Fax:419-824-1764
Practice Address - Street 1:5308 HARROUN RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2193
Practice Address - Country:US
Practice Address - Phone:419-824-5640
Practice Address - Fax:419-824-5744
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007277207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000312387OtherANTHEM
OH363768152OtherTRICARE
OH04365OtherPARAMOUNT
OH2408853Medicaid
OH23-83916OtherUHC
OH363768152-002OtherMMOH
OH7325490OtherAETNA
OH23-83916OtherUHC
OHH92570Medicare UPIN