Healthcare Provider Details

I. General information

NPI: 1700885977
Provider Name (Legal Business Name): OLIVER L PUTTLER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3798 JANES RD SUITE 15
ARCATA CA
95521-4753
US

IV. Provider business mailing address

3798 JANES RD SUITE 15
ARCATA CA
95521-4753
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-1131
  • Fax: 707-822-0746
Mailing address:
  • Phone: 707-822-1131
  • Fax: 707-822-0746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG13904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: