Healthcare Provider Details

I. General information

NPI: 1942349592
Provider Name (Legal Business Name): NAOMI C PURDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 11/14/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 13TH ST
BOULDER CO
80304-4104
US

IV. Provider business mailing address

1735 S PUBLIC RD
LAFAYETTE CO
80026-7093
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-3036
  • Fax:
Mailing address:
  • Phone: 303-665-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0071542
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: