Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | Q5907 | TX |
NPI | 1003183484 |
---|---|
Provider Name | David L. Purtle |
First Address | San Antonio, TX 78228-1440 |
Second Address | Austin, TX 78734-5386 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2011 |
Last Update Date | 15/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3517526-01 | WELLMED MEDICAID (01) | TX |