Healthcare Provider Details

I. General information

NPI: 1619259595
Provider Name (Legal Business Name): DANIEL PUTTERMAN AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SW US VETERANS HOSPITAL RD PVAMC-NCRAR P5
PORTLAND OR
97239-2964
US

IV. Provider business mailing address

3710 SW US VETERANS HOSPITAL RD PVAMC-NCRAR P5
PORTLAND OR
97239-2964
US

V. Phone/Fax

Practice location:
  • Phone: 503-220-8262
  • Fax:
Mailing address:
  • Phone: 503-220-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23487
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: