Individual
MR. HARVEY WILLIS PUTNAM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2835 E HIGHWAY 76, SUITE 3, MULLINS, SC 29574-6038
(843) 423-0230
(843) 423-0802
Mailing address
2234 COLONIAL BLVD, ATTN: PAYER CONTRACTING & RELATIONS, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1074
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0827PA
—
SC
01
—
19CQ2
BCBS NC
NC
01
—
7736884
AETNA
SC
01
—
80026764
SELECT HEALTH
SC
05
—
8103265
—
NC
01
—
933312
WELLCARE
SC
01
—
P01210111
RAILROAD MCR
SC
Enumeration date
05/17/2006
Last updated
07/15/2015
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