Provider Demographics
NPI:1174646566
Name:PUTZER, GERALD ROMAN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ROMAN
Last Name:PUTZER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-4523
Mailing Address - Country:US
Mailing Address - Phone:719-276-1806
Mailing Address - Fax:
Practice Address - Street 1:833 SELL AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4523
Practice Address - Country:US
Practice Address - Phone:719-275-6433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79626163W00000X
COAPN.0000569367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse