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General NPI Number Information
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NPI Number | 1275812091
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Entity Type | Organization
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Legal Business Name | O L PUTTLER JR MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 09/12/2017
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Provider Practice Location Address
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Address Line | 3798 JANES RD SUITE 15
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City | ARCATA
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State | CA
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Zip | 95521-4753
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Country | US
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Telephone | 707-822-1131
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Fax | 707-822-0746
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Provider Business Mailing Address
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Address Line | 3798 JANES RD SUITE 15
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City | ARCATA
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State | CA
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Zip | 95521-4753
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Country | US
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Telephone | 707-822-1131
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Fax | 707-822-0746
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Authorized Official
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Title or Position | OWNER
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Name | OLIVER L PUTTLER JR.
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Credential | MD
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Telephone | 707-822-1131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | G13904
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License Number State | CA
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