Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD00016138 | WA |
Y | 207RA0401X | Internist - Addiction Medicine | MD00016138 | WA |
NPI | 1508087669 |
---|---|
Provider Name | John D. Putnam |
First Address | Seattle, WA 98124-1581 |
Second Address | Puyallup, WA 98373 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 31/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8423402 | (05) | WA |
E72537 | (02) | WA |