Individual
DOUGLAS J VAN PUTTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD,FACS
Contact information
Practice address
11370 ANDERSON ST # 1800, LOMA LINDA, CA 92354-3450
(909) 558-2154
(909) 558-2180
Mailing address
11370 ANDERSON ST # 1800, LOMA LINDA, CA 92354-3450
(909) 558-2154
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
01039408A
IN
207W00000X
Ophthalmology Physician
Primary
G58345
CA
208200000X
Plastic Surgery Physician
01039408A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000342157
ANTHEM BC/BS
IN
01
—
01039408A
PHYSICIAN LICENSE
IN
05
—
100335580
—
IN
Enumeration date
12/23/2005
Last updated
09/25/2023
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