Provider Demographics
NPI:1346647435
Name:PUTNAM NEUROLOGY GROUP, INC.
Entity Type:Organization
Organization Name:PUTNAM NEUROLOGY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAWZI
Authorized Official - Middle Name:YOUSEF
Authorized Official - Last Name:ELSAGGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-385-3043
Mailing Address - Street 1:800 ZEAGLER DR
Mailing Address - Street 2:SUITE #230
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3883
Mailing Address - Country:US
Mailing Address - Phone:386-385-3043
Mailing Address - Fax:386-385-3187
Practice Address - Street 1:800 ZEAGLER DR
Practice Address - Street 2:SUITE #230
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3883
Practice Address - Country:US
Practice Address - Phone:386-385-3043
Practice Address - Fax:386-385-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108923174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty