Provider Demographics
NPI:1760621460
Name:PUTNAM, NATHAN J (MS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:J
Last Name:PUTNAM
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 N. 14TH AVE.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-551-2244
Mailing Address - Fax:406-551-2245
Practice Address - Street 1:1165 N. 14TH AVE.
Practice Address - Street 2:SUITE 1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-551-2244
Practice Address - Fax:406-551-2245
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAUD400231H00000X
MT1284231H00000X
CO237600000X
MT408237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAUD400OtherAUDIOLOGY LIC
COCO40925Medicare PIN
COAUD400OtherAUDIOLOGY LIC