Healthcare Provider Details

I. General information

NPI: 1245290741
Provider Name (Legal Business Name): DAVID M PURO MD, FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 JOHNSON AVE STE 101
SAN LUIS OBISPO CA
93401-4154
US

IV. Provider business mailing address

1941 JOHNSON AVE STE 101
SAN LUIS OBISPO CA
93401-4154
US

V. Phone/Fax

Practice location:
  • Phone: 805-782-8844
  • Fax: 805-782-8859
Mailing address:
  • Phone: 805-782-8844
  • Fax: 805-782-8859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG56853
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberG56853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: