MEDICARE: DR. GARY THOMAS PURCELL M.D.

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	207X00000X	Orthopaedic Surgery Physician	26179	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215917463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY THOMAS PURCELL M.D.

Provider Business Mailing Address
First Line	:	4566 E INVERNESS AVE
Second Line	:	SUITE 202
City	:	MESA
State	:	AZ
Zip	:	85206-4633
Country	:	US
Telephone Number	:	480-635-0070
Fax Number	:	480-635-0090

Provider Business Practice Location Address
First Line	:	4566 E INVERNESS AVE
Second Line	:	SUITE 202
City	:	MESA
State	:	AZ
Zip	:	85206-4633
Country	:	US
Telephone Number	:	480-635-0070
Fax Number	:	480-635-0090

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

Provider Enumeration Date	:	01/21/2006
Last Update Date	:	06/02/2020

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