MEDICARE: BILL H PURYEAR

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		TX

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679753685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BILL H PURYEAR

Provider Business Mailing Address
First Line	:	4010 E BELKNAP ST
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76111-6609
Country	:	US
Telephone Number	:	817-834-7161
Fax Number	:	817-834-7104

Provider Business Practice Location Address
First Line	:	4010 E BELKNAP ST
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76111-6609
Country	:	US
Telephone Number	:	817-834-7161
Fax Number	:	817-834-7104

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BILL H PURYEAR
Credential	:	D.O.
Telephone Number	:	817-834-7161

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	06/13/2008

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Directions to “BILL H PURYEAR ” Practice Location

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