Provider Demographics
NPI:1144475328
Name:PUCKETT, CARRIE MARGARET (DO)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:MARGARET
Last Name:PUCKETT
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Gender:F
Credentials:DO
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Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPARTMENT 358
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3311 RIVERBEND DRIVE
Practice Address - Street 2:OREGON HEART AND VASCULAR INSTITUTE
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477
Practice Address - Country:US
Practice Address - Phone:541-484-4332
Practice Address - Fax:541-242-6770
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2016-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORDO155470207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease