Healthcare Provider Details

I. General information

NPI: 1598104101
Provider Name (Legal Business Name): MERLIN STANLEY PUTERBAUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 LASSEN ST # 1
LOS ALTOS CA
94022-3986
US

IV. Provider business mailing address

480 LASSEN ST # 1
LOS ALTOS CA
94022-3986
US

V. Phone/Fax

Practice location:
  • Phone: 650-941-7488
  • Fax:
Mailing address:
  • Phone: 650-941-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number30316
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC 29719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: