Doctor Name: | DR. EDWARD J PUTTRE |
NPI Number: | 1912183955 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | G22264 |
Business Practice Address: | 1800 Western Ave Ste 101 San Bernardino, CA - 924111352 |
Business Phone Number: | 9098873937 |
Business Fax Number: | 9098879698 |
Mailing Address: | 1800 Western Ave Ste 101, SAN BERNARDINO |
State: | CA |
Postal Code: | 924111352 |
Phone Number: | 9098873937 |
Fax Number: | 9098879698 |
NPI Enumeration Date: | 01/19/2008 |
NPI Last Update Date: | 01/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | G22264 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |