Healthcare Provider Details

I. General information

NPI: 1053604793
Provider Name (Legal Business Name): ADAM PURTELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 22ND PL
LUBBOCK TX
79410-1317
US

IV. Provider business mailing address

3509 22ND ST
LUBBOCK TX
79410-1307
US

V. Phone/Fax

Practice location:
  • Phone: 806-799-7928
  • Fax: 806-788-8560
Mailing address:
  • Phone: 806-799-7928
  • Fax: 806-788-8500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10040260
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: