Provider Demographics
NPI:1740272533
Name:PUTZ, ERIC J (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:PUTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 MISSION ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-6222
Mailing Address - Country:US
Mailing Address - Phone:503-814-0273
Mailing Address - Fax:503-814-0299
Practice Address - Street 1:885 MISSION ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-6222
Practice Address - Country:US
Practice Address - Phone:503-814-0273
Practice Address - Fax:503-814-0299
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23705207RC0000X, 207RC0001X, 207RI0011X
WI18820-20207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286850Medicaid
OR286850Medicaid
ORH55360Medicare UPIN
OR112439Medicare PIN