Individual
MR. MARSHALL EDWARD PUTNAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
217 GLENSFORD DR, FAYETTEVILLE, NC 28314-0892
(910) 483-4647
(910) 483-6431
Mailing address
165 RUTH CIR, FUQUAY VARINA, NC 27526-4209
(919) 818-4755
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
103249
NC
363AM0700X
Medical Physician Assistant
Primary
103249
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8102360
—
NC
Enumeration date
05/30/2006
Last updated
12/10/2019
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