MEDICARE: DAVID W PURNER M.D.

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	207Q00000X	Family Medicine Physician	00013143	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	631053058027	OTHER	AL	TRICARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	51536438	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1083623987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID W PURNER M.D.

Provider Business Mailing Address
First Line	:	12205 COUNTY LINE RD
Second Line	:	SUITE B
City	:	MADISON
State	:	AL
Zip	:	35758-7719
Country	:	US
Telephone Number	:	256-325-4365
Fax Number	:	256-461-0393

Provider Business Practice Location Address
First Line	:	12205 COUNTY LINE RD
Second Line	:	SUITE B
City	:	MADISON
State	:	AL
Zip	:	35758-7719
Country	:	US
Telephone Number	:	256-325-4365
Fax Number	:	256-461-0393

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	06/16/2011

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