Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 57658-20 | WI |
N | 207Q00000X | Family Doctor | 72259 | MA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 57658-20 | WI |
NPI | 1912973942 |
---|---|
Provider Name | Andrew Taylor Putney |
First Address | Portage, WI 53901-0301 |
Second Address | Portage, WI 53901-3403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 22/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E86254 | (02) |