Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 02002559A | HI |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | DOSR-54 | IN |
NPI | 1053398339 |
---|---|
Provider Name | Dr. Eric Burl Purdom |
First Address | Tripler Amc, HI 96859-5001 |
Second Address | Tripler Amc, HI 96859-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 08/07/2007 |