Individual
SAMUEL GRADY PUTNAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 PHYSICIANS LN, SOUTHAVEN, MS 38671-9569
(662) 655-2136
(662) 996-2214
Mailing address
26500 AGOURA RD STE 102-587, CALABASAS, CA 91302-1952
(818) 880-8605
(818) 579-7916
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
25MA09575600
NJ
2085R0202X
Diagnostic Radiology Physician
C1-0011573
DE
2085R0202X
Diagnostic Radiology Physician
MD041221E
PA
2085R0204X
Vascular & Interventional Radiology Physician
25MA09575600
NJ
2085R0204X
Vascular & Interventional Radiology Physician
Primary
28916
MS
2085R0204X
Vascular & Interventional Radiology Physician
63241
TN
2085R0204X
Vascular & Interventional Radiology Physician
C1-0011573
DE
2085R0204X
Vascular & Interventional Radiology Physician
MD-23034
HI
2085R0204X
Vascular & Interventional Radiology Physician
MD041221E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012723560016
—
PA
01
—
0546464000
AMERIHEALTH/INTERCOUNTY
PA
01
—
1172545
AETNA HMO
PA
01
—
300099781
RRM
PA
01
—
30026885
KEYSTONE MERCY
PA
01
—
710371
HIGHMARK BLUE SHIELD
PA
01
—
7929044
AETNA PPO
PA
01
—
8215722
CIGNA HMO/PPO
PA
Enumeration date
05/05/2006
Last updated
05/06/2025
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