Healthcare Provider Details

I. General information

NPI: 1275109498
Provider Name (Legal Business Name): ADAM ROBERT PUTNAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WESTWOOD DR STE I
HAMILTON MT
59840-2345
US

IV. Provider business mailing address

1200 WESTWOOD DR
HAMILTON MT
59840-2345
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-1100
  • Fax: 406-375-4884
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMED-PHYS-LIC-144233
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: