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General NPI Number Information
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NPI Number | 1609197227
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Entity Type | Individual
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Provider Name | RUSSELL WALKER PUTNAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 2850 LEWIS LN STE 101
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City | PARIS
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State | TX
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Zip | 75460-9378
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Country | US
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Telephone | 903-784-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 495 JOHNSON WOODS DR
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City | PARIS
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State | TX
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Zip | 75460-6332
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Country | US
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Telephone | 214-763-1987
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | P3956
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License Number State | TX
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