Individual
JENNIFER ROBIN PUTNAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1342 S DOUGLAS BLVD, SUITE A, MIDWEST CITY, OK 73130-5215
(405) 455-3322
(405) 455-3358
Mailing address
8 SW 89TH ST, STE 100, OKLAHOMA CITY, OK 73139-8534
(405) 455-3322
(405) 606-4338
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2115
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208362023
GROUP TAX-ID
—
Enumeration date
09/17/2009
Last updated
02/14/2017
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