Provider Demographics
NPI:1437110368
Name:PUTNAM, CATHEY A (MD)
Entity Type:Individual
Prefix:
First Name:CATHEY
Middle Name:A
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S 500 E
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3460 PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2049
Practice Address - Country:US
Practice Address - Phone:801-964-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT280092-1205207PE0004X, 207PE0005X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT238702OtherALTIUS
UT608832600OtherW/C
UT908246OtherAHCCCS MEDICAID
UTB003OtherTRICARE
UT1141OtherHEALTHY U MEDICAID
UTD1204Medicaid
UT106033900OtherDEPT OF LABOR
UTP00395858OtherRAILROAD
UT930091496OtherRAILROAD MEDICARE
UTB003OtherTRICARE
UT106033900OtherDEPT OF LABOR
UT930091496OtherRAILROAD MEDICARE
UTP00395858OtherRAILROAD
UT005568313Medicare PIN