Provider Demographics
NPI:1508193327
Name:PUTNAM PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:PUTNAM PHYSICIAN PRACTICES LLC
Other - Org Name:ORTHOPEDICS AND SPORTS SPECIALISTS OF PUTNAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8508
Mailing Address - Street 1:3314 CRILL AVE
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-4162
Mailing Address - Country:US
Mailing Address - Phone:386-328-4242
Mailing Address - Fax:386-328-4244
Practice Address - Street 1:3314 CRILL AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4162
Practice Address - Country:US
Practice Address - Phone:386-328-4242
Practice Address - Fax:386-328-4244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty