Individual
DR. MICHAEL STUART PUTLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14200 W FILLMORE ST, GOODYEAR, AZ 85338-3005
(623) 207-3000
Mailing address
14200 W FILLMORE ST, GOODYEAR, AZ 85338-3005
(623) 207-3000
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
ME88971
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000925383B
—
GA
05
—
268691100
—
FL
01
—
82513
INDIVIDUAL BCBS ID NUMBER
FL
01
—
99039
GROUP BCBS ID NUMBER
FL
01
—
AJ564
MEDICARE GIN
FL
01
—
P00625816
MEDICARE RAIL ROAD
FL
Enumeration date
05/23/2005
Last updated
07/30/2010
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