DR. JOHN WILLIS PUCKETT (NPI# 1306938022) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306938022 |
| Entity Type | Individual |
| Full Name | DR. JOHN WILLIS PUCKETT |
| Credential | MD |
| Practice Address |
520 Superior Ave #370 Newport Beach CA 92663-3637 |
| Practice Telephone | 9495747176 |
| Practice Fax Number | 9495747180 |
| Mailing Telephone | 9495747176 |
| Mailing Fax Number | 9495747180 |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2014-01-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
G38172A | CA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013993492 | John H. Puckett | Dentist | 624 W. Court St., Suite A, Pargould, AR 72450-4247 | 2005-12-19 |
| 1447861695 | John Puckett | Behavior Technician | 9813 Coda Pl Ne, Albuquerque, NM 87111-3544 | 2020-08-12 |
| 1073141404 | John Austin Puckett | Internal Medicine | 2500 N State St, Jackson, MS 39216-4500 | 2020-03-31 |
| 1225396872 | John Stuart Puckett | Anesthesiology | 911 Bypass Rd, Pikeville, KY 41501-1689 | 2012-05-01 |
| 1396981908 | John Martin Puckett | Contractor | 453 West Main Street, Mount Orab, OH 45154 | 2009-01-02 |
| Street Address |
520 SUPERIOR AVE #370 |
| City | NEWPORT BEACH |
| State | CA |
| Zip Code | 92663-3637 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275536773 | Khosrow Mahdavi | Specialist | 520 Superior Ave, #315, Newport Beach, CA 92663-3637 | 2005-05-27 |
| 1770113623 | Kelly Watkins | Family Medicine | 520 Superior Ave, Newport Beach, CA 92663-3637 | 2020-01-20 |
| 1548819071 | Care Connectors Affiliated Physicians Inc | Clinic/Center | 520 Superior Ave, Suite 250, Newport Beach, CA 92663 | 2019-09-07 |
| 1275189813 | Kerry Lamb | Physician Assistant | 520 Superior Ave, Newport Beach, CA 92663-3637 | 2019-08-09 |
| 1649714627 | Eugene Alexander Yamamoto | Physician Assistant | 520 Superior Ave, #270, Newport Beach, CA 92663-3637 | 2016-12-11 |
| 1659727865 | Ralli and Grewal Apc | Internal Medicine | 520 Superior Ave, Suite 390, Newport Beach, CA 92663-3637 | 2016-05-05 |
| 1083020606 | Li Si Zeng | Physician Assistant | 520 Superior Ave, Suite 270, Newport Beach, CA 92663-3637 | 2014-07-02 |
| 1376960443 | Spn Medical Consulting | Clinic/Center | 520 Superior Ave, Suite 350, Newport Beach, CA 92663-3637 | 2014-03-26 |
| 1275955668 | David R Reinstadler M.d. Inc | Otolaryngology | 520 Superior Ave, Suite 240, Newport Beach, CA 92663-3637 | 2014-01-20 |
| 1821426537 | John C Champion Md | Internal Medicine | 520 Superior Ave, Suite 290, Newport Beach, CA 92663-3637 | 2013-10-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851905483 | Oasis Anesthesia, Surgical and Medical Group, Inc | Anesthesiology | 496 Old Newpor Blvd., Suite 2, Newport Beach, CA 92663 | 2020-09-01 |
| 1699232801 | Megan Gregor | Surgery | One Hoag Dr., Bldg 41, Ste 122, Newport Beach, CA 92663 | 2019-02-24 |
| 1831621382 | Narges Maududi | Social Worker | 1965 Sherrington Place, K111, Newport Beach, CA 92663 | 2017-04-03 |
| 1225495153 | Mitchelle Giorgi | Physical Therapist | 351 Hospital Road, Suite 007, Newport Beach, CA 92663 | 2016-01-22 |
| 1043620057 | Leslie Mccormack | Speech-Language Pathologist | 270 Cagney Lane #101, Newport Beach, CA 92663 | 2014-04-29 |
| 1265867162 | Hotel California By The Sea, LLC | Substance Abuse Rehabilitation Facility | 4504 Seashore Drive, Newport Beach, CA 92663 | 2013-09-10 |
| 1538504733 | Shawn Zardouz | Psychiatry & Neurology | 3900 W Coast Hwy Ste 390, Newport Beach, CA 92663 | 2013-05-02 |
| 1326330119 | Denise Fortenberry Fortenberry-gratias | Nurse Practitioner | 520 Superior Ave, Suite 350, Newport Beach, CA 92663 | 2011-05-11 |
| 1043500390 | Romit Kumar Kar | Pediatrics | 355 Placentia Ave Ste 301, Newport Beach, CA 92663 | 2011-04-07 |
| 1477858546 | Newport Neurohospitalists | Neurological Surgery | 510 Superior Ave Ste 280, Newport Beach, CA 92663 | 2011-01-20 |
| Find all providers in zip 92663 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841419454 | John W Puckett Md Facs Inc | Surgery | 520 Superior Ave., #370, Newport Beach, CA 92663-3623 | 2007-04-24 |
| 1154375780 | Heather Brien | Surgery | 361 Hospital Rd Ste 227, Newport Beach, CA 92663-3523 | 2006-05-19 |
| 1548626294 | Newport Coast Vein Care, Inc. | Surgery | 447 Old Newport Blvd, Suite 200, Newport Beach, CA 92663-4257 | 2016-01-11 |
| 1730427303 | David Nabi, Md, Facs, Inc. | Surgery | 520 Superior Ave, Suite 370, Newport Beach, CA 92663-3637 | 2013-01-16 |
| 1609133511 | Peripheral Vascular Associates, Inc. | Surgery | 4501 Birch St, Newport Beach, CA 92660-1990 | 2012-04-16 |
| 1104190941 | Orange County Vascular Specialists, Inc. | Surgery | 520 Superior Ave, Suite 370, Newport Beach, CA 92663-3637 | 2012-02-24 |
| 1770748030 | Prabhjot Kaur Grewal | Surgery | 4501 Birch St, Newport Beach, CA 92660-1990 | 2008-07-25 |
| 1811185655 | David Nabi | Surgery | 520 Superior Ave, Suite 370, Newport Beach, CA 92663-3637 | 2007-10-05 |
| 1740498112 | Richard B Doering M D Inc | Surgery | 351 Hospital Rd, Ste 401, Newport Beach, CA 92663-3509 | 2007-05-18 |
| 1982810594 | Maraya Altuwaijri, M.d., A Medical Corporation | Surgery | 351 Hospital Rd, Suite 415, Newport Beach, CA 92663-3509 | 2007-05-14 |
| Find all providers in NEWPORT BEACH | ||||
| City | NEWPORT BEACH |
| Zip Code | 92663 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.