Individual
DR. JERRY S PUTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 571-7627
(888) 575-8182
Mailing address
6459 ROCHESTER WAY, TYLER, TX 75703-4274
(903) 571-7627
(888) 575-8182
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
F-4396
TX
207VG0400X
Gynecology Physician
F4396
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
760247287
MEDICARE, STATE OF TX
TX
Enumeration date
01/07/2008
Last updated
11/11/2014
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