Healthcare Provider Details

I. General information

NPI: 1902807209
Provider Name (Legal Business Name): JOSEPH L PUTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 W 7TH ST
AUBURN IN
46706-2013
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-927-0400
  • Fax: 260-927-0440
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01057980A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: