SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC – NPI #1629025820
Orthopaedic Surgery

An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

Health Care Provider Taxonomy Code for Orthopaedic Surgery

SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC is an orthopaedic surgeon located in JACKSONVILLE, FL. NPPES has assigned the NPI number 1629025820 to SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC on May 31, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. According to the NPI Registry, there are 16 additional location(s) assigned to this provider which are listed below. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207X00000X from the Health Care Provider Taxonomy code set, which is classified as Orthopaedic Surgery. Bear in mind that having a taxonomy code selected doesn't replace any credentialing or validation process that may be required by law.

The NPI profile was last updated on Dec 09, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC below.

NPI Profile for
SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC

NPI Number
1629025820
Enumeration Date

(more than 20 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC
Primary location
2627 RIVERSIDE AVE FL 3
JACKSONVILLE, FL 32204-4717
Phone: (904) 634-0640 Fax: (904) 634-0203
16 Other location(s):
4565 US Highway 17 Ste 200
Fleming Island, FL 32003-4823
Phone: (904) 634-0640
Fax: (904) 634-0203
10475 Centurion Pkwy N Ste 220
Jacksonville, FL 32256-5004
Phone: (904) 634-0640
Fax: (904) 634-0203
10475 Centurion Pkwy N Ste 301
Jacksonville, FL 32256-5004
Phone: (904) 634-0640
Fax: (904) 634-0203
10475 Centurion Pkwy N Ste 305
Jacksonville, FL 32256-5004
Phone: (904) 634-0640
Fax: (904) 634-0203
15255 Max Legget Pkwy Ste 5300
Jacksonville, FL 32218-7274
Phone: (904) 634-0640
Fax: (904) 634-0640
2 Shircliff Way Ste 605
Jacksonville, FL 32204-4762
Phone: (904) 634-0640
Fax: (904) 634-0203
2110 Herschel St
Jacksonville, FL 32204-3820
Phone: (904) 634-0640
Fax: (904) 634-0203
4268 Oldfield Crossing Dr Ste 201
Jacksonville, FL 32223-8800
Phone: (904) 634-0640
Fax: (904) 634-0203
2300 Park Ave Ste 206
Orange Park, FL 32073-5573
Phone: (904) 634-0640
Fax: (904) 634-0203
232 Ponte Vedra Park Dr
Ponte Vedra Beach, FL 32082-6600
Phone: (904) 634-0640
Fax: (904) 634-0203
1690 US Highway 1 S Ste F
St Augustine, FL 32084-6024
Phone: (904) 634-0640
Fax: (904) 634-0203
216 Southpark Cir E
St Augustine, FL 32086-5135
Phone: (904) 634-0640
Fax: (904) 634-0203
45 Groover Loop Ste 201
St Augustine, FL 32086-6586
Phone: (904) 634-0640
Fax: (904) 634-0203
300 Saint Elizabeth Way Ste 210
St Johns, FL 32259-1153
Phone: (904) 634-0640
Fax: (904) 634-0203
3055 County Road 210 W Ste 110
St Johns, FL 32259-7001
Phone: (904) 634-0640
Fax: (904) 634-0640
615 Pendleton St Ste B
Waycross, GA 31501-4760
Phone: (904) 634-0640
Fax: (904) 634-0203
Mailing address
6800 SOUTHPOINT PKWY STE 300
JACKSONVILLE, FL 32216-8203
Phone: (904) 634-0640 Fax: (904) 634-0203
Organization Subpart
No
Authorized Official
BRETT PUCKETT
AUTHORIZED OFFICIAL
Phone: (904) 634-0640
Updated
Certification Date
Dec 09, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

See identifiers
DescriptionIssuerStateIdentifier
medicaidFL107540808
medicaidFL107540811
medicaidFL107540814
medicaidFL107540817
medicaidFL107540805
medicaidFL107540810
medicaidFL107540813
medicaidFL107540807
medicaidFL107540818
medicaidFL107540800
medicaidFL107540816
medicaidFL107540819
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207X00000X
- Orthopaedic Surgery (Primary)
213E00000X
- Podiatrist
208VP0014X
- Pain Medicine / Interventional Pain Medicine
208VP0000X
- Pain Medicine / Pain Medicine
207XX0801X
- Orthopaedic Surgery / Orthopaedic Trauma
207XX0005X
- Orthopaedic Surgery / Sports Medicine
207XX0004X
- Orthopaedic Surgery / Foot and Ankle Surgery
207XS0114X
- Orthopaedic Surgery / Adult Reconstructive Orthopaedic Surgery
207XS0106X
- Orthopaedic Surgery / Hand Surgery
207QS0010X
- Family Medicine / Sports Medicine
174400000X
- Specialist

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.