Healthcare Provider Details

I. General information

NPI: 1184745150
Provider Name (Legal Business Name): CHAD W PUTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5204 W REDBUD ST
ROGERS AR
72758-8936
US

IV. Provider business mailing address

5204 W REDBUD ST
ROGERS AR
72758-8936
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-0110
  • Fax: 479-636-0491
Mailing address:
  • Phone: 479-636-0110
  • Fax: 479-636-0491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberE-9602
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: