Healthcare Provider Details

I. General information

NPI: 1962450320
Provider Name (Legal Business Name): STEVEN DENNIS PURDY P.A.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MACK RD
FAIRFIELD OH
45014-5335
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 513-870-7001
  • Fax: 934-619-4150
Mailing address:
  • Phone: 800-875-0136
  • Fax: 937-619-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50002322
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: