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NPI Code Detail

MEDICARE: LESLIE PUTMAN PA

MEDICARE: LESLIE PUTMAN PA
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
1363A00000XPhysician AssistantPA3042FL
2363A00000XPhysician Assistant055.0031618VT

Other Identifiers

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

General Provider Information

NPI Number : 1902874647
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE PUTMAN PA
Provider Business Mailing Address
First Line : 926 NW 13TH AVE
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33426-2947
Country : US
Telephone Number : 561-738-3184
Fax Number :
Provider Business Practice Location Address
First Line : 115 PORTER DR
Second Line :
City : MIDDLEBURY
State : VT
Zip : 05753-8629
Country : US
Telephone Number : 802-388-4430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 05/22/2025

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Directions to “ LESLIE PUTMAN PA” Practice Location

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