Healthcare Provider Details

I. General information

NPI: 1568428803
Provider Name (Legal Business Name): LARRY P PUTNAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 E PIMA SUITE E
TUCSON AZ
85712
US

IV. Provider business mailing address

5700 E PIMA SUITE E
TUCSON AZ
85712
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-2030
  • Fax: 520-324-2619
Mailing address:
  • Phone: 520-324-2030
  • Fax: 520-324-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9233
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: