Healthcare Provider Details

I. General information

NPI: 1194899286
Provider Name (Legal Business Name): ADAM J PUTNAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR CSV EMERGENCY DPT
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

PO BOX 2611
SANTA FE NM
87504-2611
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-3361
  • Fax:
Mailing address:
  • Phone: 412-977-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2007-0511
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: