Healthcare Provider Details

I. General information

NPI: 1710987102
Provider Name (Legal Business Name): CARMEN PURL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E. 4TH
SUNRAY TX
79086
US

IV. Provider business mailing address

PO BOX 97
SUNRAY TX
79086-0097
US

V. Phone/Fax

Practice location:
  • Phone: 806-948-1459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberHO730
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: