Provider Demographics
NPI:1871525378
Name:PUCK, JENNIFER M (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:PUCK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:550 16TH ST
Mailing Address - Street 2:BOX 0434
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143
Mailing Address - Country:US
Mailing Address - Phone:415-502-2090
Mailing Address - Fax:415-502-2107
Practice Address - Street 1:1825 FOUTH STREET, 6TH FLOOR
Practice Address - Street 2:IMMUNOLOGY CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158
Practice Address - Country:US
Practice Address - Phone:415-502-2090
Practice Address - Fax:415-502-2107
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG87720208000000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G877200Medicaid
CA00G877200Medicare PIN