Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 20A10303 | CA |
NPI | 1013100742 |
---|---|
Provider Name | Annie Davidson Purcell |
First Address | Redding, CA 96099-2316 |
Second Address | Redding, CA 96001-0443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2007 |
Last Update Date | 26/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZZZ58464Y | BLUE SHIELD (01) | CA |