Organization
CARTHAGE RADIOLOGOSTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE E PUTNAM DO (OWNER)
(417) 358-1244
Entity
Organization
Contact information
Practice address
1515 HAZEL ST, CARTHAGE, MO 64836-2850
(417) 358-1244
(417) 358-7157
Mailing address
PO BOX 871, CARTHAGE, MO 64836-0871
(417) 358-1244
(417) 358-7157
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0203X
Therapeutic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000011418
MEDICARE
MO
05
—
502736101
—
MO
Enumeration date
04/25/2008
Last updated
05/07/2008
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