Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 4510 | SC |
Y | 1223G0001X | General Practice | 4510 | SC |
Y | 213EG0000X | General Practice | 4510 | SC |
NPI | 1467605329 |
---|---|
Provider Name | Dr. Julie Putman |
First Address | Danville, IL 61832-5100 |
Second Address | Danville, IL 61832-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2008 |
Last Update Date | 29/04/2013 |