Healthcare Provider Details

I. General information

NPI: 1073600193
Provider Name (Legal Business Name): JOE B PUTNAM JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PALM AVE STE 600
JACKSONVILLE FL
32207-8432
US

IV. Provider business mailing address

PO BOX 746654
ATLANTA GA
30374-6654
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-7300
  • Fax: 904-202-2754
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME125498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: