Provider Demographics
NPI:1457517203
Name:PUTNAM PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:PUTNAM PHYSICIAN PRACTICES LLC
Other - Org Name:PUTNAM SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:414 ZEAGLER DR
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3815
Mailing Address - Country:US
Mailing Address - Phone:386-328-4123
Mailing Address - Fax:386-328-4125
Practice Address - Street 1:414 ZEAGLER DR
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3815
Practice Address - Country:US
Practice Address - Phone:386-328-4123
Practice Address - Fax:386-328-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBL990AOtherMEDICARE PTAN