Healthcare Provider Details

I. General information

NPI: 1013988120
Provider Name (Legal Business Name): JAMES S PUTNAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 SW BARNES RD
PORTLAND OR
97225-6603
US

IV. Provider business mailing address

9400 SW BARNES RD SUITE 307
PORTLAND OR
97225-6608
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-4830
  • Fax: 503-216-4850
Mailing address:
  • Phone: 503-292-9108
  • Fax: 503-292-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number13680
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: