Organization
PUTNAM FAMILY PRACTICE ASSOCIATES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL WATSON PETERSON M.D. (PRESIDENT)
(304) 757-6736
Entity
Organization
Contact information
Practice address
3952 TEAYS VALLEY RD, HURRICANE, WV 25526-8728
(304) 757-6736
(304) 757-0582
Mailing address
3952 TEAYS VALLEY RD, HURRICANE, WV 25526-8728
(304) 757-6736
(304) 757-0582
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14044
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0057148000
—
WV
01
—
1184694739
NPI (INDIVIDUAL)
WV
Enumeration date
02/20/2007
Last updated
10/07/2011
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