Healthcare Provider Details

I. General information

NPI: 1710998992
Provider Name (Legal Business Name): RALPH N PURCELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20940 N TATUM BLVD DESERT RIDGE MEDICAL CAMPUS BLDG B STE 290
PHOENIX AZ
85050
US

IV. Provider business mailing address

ATO LOCKBOX PO BOX 202583
DALLAS TX
75320-2583
US

V. Phone/Fax

Practice location:
  • Phone: 480-538-2161
  • Fax: 480-585-9961
Mailing address:
  • Phone: 480-538-2161
  • Fax: 480-585-9961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number162493-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: