MEDICARE: DR. MARWAN PURGHOL MD

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	2084N0400X	Neurology Physician	L0520	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8R7190	OTHER	TX	BC INDIVIDUAL PROV NUM
2	L0520	OTHER	TX	MEDICAL LICENSE
3	0004MG	OTHER	TX	BC GROUP NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689607350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARWAN PURGHOL MD

Provider Business Mailing Address
First Line	:	PO BOX 1283
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-1283
Country	:	US
Telephone Number	:	409-729-6700
Fax Number	:	409-729-6705

Provider Business Practice Location Address
First Line	:	3000 39TH ST
Second Line	:	SUITE103
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5517
Country	:	US
Telephone Number	:	409-729-6700
Fax Number	:	409-729-6705

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	09/10/2015

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