Individual
DR. RUSSELL PUTNAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12554 RIATA VISTA CIR, AUSTIN, TX 78727-6431
(512) 795-5100
(512) 795-5122
Mailing address
12554 RIATA VISTA CIR, AUSTIN, TX 78727-6431
(512) 795-5100
(512) 795-5122
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
K0364
TX
2085R0202X
Diagnostic Radiology Physician
Primary
K0364
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141288403
—
TX
05
—
141288404
—
TX
01
—
141288406
CSHCN1
TX
01
—
141288408
CSHCN2
TX
01
—
300133592
RRMCARE2
—
01
—
300133594
RRMCARE
—
Enumeration date
06/10/2005
Last updated
04/05/2021
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