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General NPI Number Information
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NPI Number | 1336159979
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Entity Type | Organization
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Legal Business Name | PUTNAM CLINICAL LABORATORIES INC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 02/13/2009
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Provider Practice Location Address
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Address Line | 700 ZEAGLER DR STE 8
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City | PALATKA
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State | FL
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Zip | 32177-3826
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Country | US
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Telephone | 386-328-4036
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Fax | 386-328-7397
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Provider Business Mailing Address
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Address Line | 700 ZEAGLER DR STE 8
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City | PALATKA
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State | FL
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Zip | 32177-3826
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Country | US
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Telephone | 386-328-4036
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Fax | 386-328-7397
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Authorized Official
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Title or Position | OWNER
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Name | ELIO MADAN
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Credential | MD
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Telephone | 386-328-4036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 800008234
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License Number State | FL
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