MEDICARE: DR. DOUGLAS A PURYEAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	90-96	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	100647	OTHER	NM	VALUE OPTIONS

General Provider Information

NPI Number	:	1053399204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS A PURYEAR MD

Provider Business Mailing Address
First Line	:	250 E ALAMEDA ST
Second Line	:	APT 507
City	:	SANTA FE
State	:	NM
Zip	:	87501-2186
Country	:	US
Telephone Number	:	505-982-9337
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 CAMINO DE VECINOS
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-7901
Country	:	US
Telephone Number	:	505-982-9337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2006
Last Update Date	:	06/04/2015

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