MEDICARE: J MICHAEL PUTMAN, MD PA

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	207VE0102X	Reproductive Endocrinology Physician	E1924	TX

General Provider Information

NPI Number	:	1184809543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J MICHAEL PUTMAN, MD PA

Provider Business Mailing Address
First Line	:	3600 GASTON AVE STE 502
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1805
Country	:	US
Telephone Number	:	214-823-2692
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE STE 502
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1805
Country	:	US
Telephone Number	:	214-823-2692
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	J MICHAEL PUTMAN
Credential	:
Telephone Number	:	214-823-2692

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	01/04/2008

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