Provider Demographics
NPI:1871569111
Name:PUTNAM, JOHN LESLIE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LESLIE
Last Name:PUTNAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4350 S NATIONAL AVE
Mailing Address - Street 2:SUITE C200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2607
Mailing Address - Country:US
Mailing Address - Phone:417-447-1000
Mailing Address - Fax:417-447-6150
Practice Address - Street 1:4350 S NATIONAL AVE
Practice Address - Street 2:SUITE C200
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2607
Practice Address - Country:US
Practice Address - Phone:417-447-1000
Practice Address - Fax:417-447-6150
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR6H15207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202509428Medicaid
MO202509428Medicaid
MO928834535Medicare ID - Type Unspecified