Provider Demographics
NPI:1306892906
Name:PUTNOKY, GILBERT J (MD)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:J
Last Name:PUTNOKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0722
Mailing Address - Country:US
Mailing Address - Phone:909-793-3311
Mailing Address - Fax:909-335-1936
Practice Address - Street 1:1690 BARTON RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4229
Practice Address - Country:US
Practice Address - Phone:909-793-3311
Practice Address - Fax:909-335-1936
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG27563207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G275630Medicaid
CAA43400Medicare UPIN