Organization
EDWARD J PUTTRE JR MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD J PUTTRE JR. MD (OWNER)
(909) 887-3937
Entity
Organization
Contact information
Practice address
1800 WESTERN AVE, SUITE 101, SAN BERNARDINO, CA 92411-1356
(909) 887-3937
(909) 887-9698
Mailing address
1800 WESTERN AVE, SUITE 101, SAN BERNARDINO, CA 92411-1356
(909) 887-3937
(909) 887-9698
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G22264
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G222640
—
CA
Enumeration date
02/13/2007
Last updated
08/23/2010
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