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NPI Code Detail

MEDICARE: PAUL DENNIS PUTT A.T., C.

MEDICARE: PAUL DENNIS PUTT A.T., C.
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
12255A2300XAthletic Trainer109936MO

General Provider Information

NPI Number : 1194719195
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL DENNIS PUTT A.T., C.
Provider Business Mailing Address
First Line : 1317 E REPUBLIC RD
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65804-7204
Country : US
Telephone Number : 417-889-4411
Fax Number :
Provider Business Practice Location Address
First Line : 1317 E REPUBLIC RD
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65804-7204
Country : US
Telephone Number : 417-889-4411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 07/08/2007

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