Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 154630 | NY |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 154630-2 | NY |
NPI | 1598883506 |
---|---|
Provider Name | Thomas Alan Putnam |
First Address | Lakewood, NY 14750-1702 |
Second Address | Lakewood, NY 14750-1702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 13/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00639487 | (05) | NY |
F41249 | (02) | |
J400082246 | PTAN (01) |