MEDICARE: DR. JOHN LESLIE PUTNAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	R6H15	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871569111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN LESLIE PUTNAM MD

Provider Business Mailing Address
First Line	:	4350 S NATIONAL AVE
Second Line	:	SUITE C200
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-2607
Country	:	US
Telephone Number	:	417-447-1000
Fax Number	:	417-447-6150

Provider Business Practice Location Address
First Line	:	4350 S NATIONAL AVE
Second Line	:	SUITE C200
City	:	SPRINGFIELD
State	:	MO
Zip	:	65810-2607
Country	:	US
Telephone Number	:	417-447-1000
Fax Number	:	417-447-6150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	11/20/2012

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