MEDICARE: POONAM PURI DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	BP10045576	TX

General Provider Information

NPI Number	:	1063852846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POONAM PURI DO

Provider Business Mailing Address
First Line	:	900 8TH AVE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-3902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 8TH AVE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-3902
Country	:	US
Telephone Number	:	817-877-5292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	12/17/2025

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Directions to “ POONAM PURI DO” Practice Location

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