Healthcare Provider Details

I. General information

NPI: 1093851529
Provider Name (Legal Business Name): CHRISTIAN T. PURGASON D.O. FACEP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL ST MAIL CODE Z-11
RENO NV
89502-1576
US

IV. Provider business mailing address

15473 KENT DR
TRUCKEE CA
96161-1266
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-4040
  • Fax: 775-324-4042
Mailing address:
  • Phone: 530-587-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A9340
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO1397
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: