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NPI Code Detail

MEDICARE: DR. BRADLEY SCOTT PUTTY M.D.

MEDICARE: DR. BRADLEY SCOTT PUTTY M.D.
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
1208600000XSurgery PhysicianQ1000TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225051774
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADLEY SCOTT PUTTY M.D.
Provider Business Mailing Address
First Line : 2215 TURKEY RUN LN
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65809-3554
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1008 S SPRING AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2520
Country : US
Telephone Number : 314-977-4717
Fax Number : 314-977-1877
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 01/11/2023

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