MEDICARE: LESLIE PUTMAN PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1124862784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLIE PUTMAN PLLC

Provider Business Mailing Address
First Line	:	926 NW 13TH AVE
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-2947
Country	:	US
Telephone Number	:	602-428-6915
Fax Number	:	602-429-8531

Provider Business Practice Location Address
First Line	:	926 NW 13TH AVE
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-2947
Country	:	US
Telephone Number	:	602-428-6915
Fax Number	:	602-429-8531

Authorized Official
Title or Position	:	MANAGER
Name	:	ADAM SYED
Credential	:
Telephone Number	:	602-428-6915

Provider Enumeration Date	:	06/19/2024
Last Update Date	:	06/19/2024

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