MEDICARE: JUSTIN PUTHOFF MD

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	208600000X	Surgery Physician	33927	OK
2	390200000X	Student in an Organized Health Care Education/Training Program
3	390200000X	Student in an Organized Health Care Education/Training Program	33927	OK

General Provider Information

NPI Number	:	1184111015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN PUTHOFF MD

Provider Business Mailing Address
First Line	:	1802 E 19TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-5403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1802 E 19TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-5403
Country	:	US
Telephone Number	:	918-634-7539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	08/12/2021

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Directions to “ JUSTIN PUTHOFF MD” Practice Location

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