Healthcare Provider Details

I. General information

NPI: 1649275181
Provider Name (Legal Business Name): MATTOX L PURVIS,JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HILYARD ST STE 470
EUGENE OR
97401-8107
US

IV. Provider business mailing address

1200 HILYARD ST STE 470
EUGENE OR
97401-8107
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-6478
  • Fax: 541-485-0452
Mailing address:
  • Phone: 541-485-6478
  • Fax: 541-485-0452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD08565
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: