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NPI Code Detail

MEDICARE: PETER PUTNAM M.D.

MEDICARE: PETER PUTNAM 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
1208000000XPediatrics Physician113311MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
196948OTHERMOGHP
223561V3431OTHERMOHEALTHCARE USA
37432234OTHERMOAETNA
4143223OTHERMOBCBS
5143223OTHERMOBLUE CHOICE
6431383893PUTOTHERMOMERCY
71200670OTHERMOUHC
8456440OTHERMOHEALTHLINK

General Provider Information

NPI Number : 1417938176
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER PUTNAM M.D.
Provider Business Mailing Address
First Line : PO BOX 23340
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63156-3340
Country : US
Telephone Number : 314-965-5437
Fax Number : 314-965-5439
Provider Business Practice Location Address
First Line : 9930 WATSON RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63126-1827
Country : US
Telephone Number : 314-965-5437
Fax Number : 314-965-5439
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 09/26/2012

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