# DOUGLAS J VAN PUTTEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1851378558
- **Gender:** Man
- **Credential:** MD,FACS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 01039408A | IN | — |
| 207W00000X | Ophthalmology Physician | G58345 | CA | Yes |
| 208200000X | Plastic Surgery Physician | 01039408A | IN | — |

## Other

- **Enumeration date:** 12/23/2005
- **Last updated:** 09/25/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000342157 | ANTHEM BC/BS | IN |
| 01 | — | 01039408A | PHYSICIAN LICENSE | IN |
| 05 | — | 100335580 | — | IN |