Provider Demographics
NPI:1174586507
Name:PUTMAN, SHAWN C (MD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:C
Last Name:PUTMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1707 MEDICAL PARK DR W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2768
Mailing Address - Country:US
Mailing Address - Phone:252-291-7008
Mailing Address - Fax:252-291-1281
Practice Address - Street 1:1707 MEDICAL PARK DR W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-2788
Practice Address - Country:US
Practice Address - Phone:252-291-7008
Practice Address - Fax:252-291-1281
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2022-05-25
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Provider Licenses
StateLicense IDTaxonomies
NC9600689207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG27628Medicare UPIN