Healthcare Provider Details

I. General information

NPI: 1487924866
Provider Name (Legal Business Name): JOHN SPRENG PUTMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9511 CORONET LN
BRENTWOOD TN
37027-8377
US

IV. Provider business mailing address

9511 CORONET LN
BRENTWOOD TN
37027-8377
US

V. Phone/Fax

Practice location:
  • Phone: 615-465-8171
  • Fax:
Mailing address:
  • Phone: 615-465-8171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS 4880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: