# EDWARD J PUTTRE JR MD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336281443
- **Authorized official:** DR. EDWARD J PUTTRE JR. MD (OWNER)
- **Authorized official phone:** (909) 887-3937

## Contact information

- **Practice address:** 1800 WESTERN AVE, SUITE 101, SAN BERNARDINO, CA 92411-1356
- **Practice address phone:** (909) 887-3937
- **Practice address fax:** (909) 887-9698
- **Mailing address:** 1800 WESTERN AVE, SUITE 101, SAN BERNARDINO, CA 92411-1356
- **Mailing address phone:** (909) 887-3937
- **Mailing address fax:** (909) 887-9698

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | G22264 | CA | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 08/23/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00G222640 | — | CA |