Healthcare Provider Details

I. General information

NPI: 1275677023
Provider Name (Legal Business Name): PUTNAM ORTHOPAEDIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 S NATIONAL AVE SUITE C200
SPRINGFIELD MO
65810-2607
US

IV. Provider business mailing address

4350 S NATIONAL AVE SUITE C200
SPRINGFIELD MO
65810-2607
US

V. Phone/Fax

Practice location:
  • Phone: 417-447-1000
  • Fax: 417-447-6150
Mailing address:
  • Phone: 417-447-1000
  • Fax: 417-447-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN LESLIE PUTNAM
Title or Position: OWNER
Credential: MD
Phone: 417-447-1000