1689607350 NPI number — DR. MARWAN PURGHOL MD

Table of content: DR. MARWAN PURGHOL MD (NPI 1689607350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689607350 NPI number — DR. MARWAN PURGHOL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PURGHOL
Provider First Name:
MARWAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689607350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1283
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEDERLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77627-1283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-729-6700
Provider Business Mailing Address Fax Number:
409-729-6705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 39TH ST
Provider Second Line Business Practice Location Address:
SUITE103
Provider Business Practice Location Address City Name:
PORT ARTHUR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77642-5517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-729-6700
Provider Business Practice Location Address Fax Number:
409-729-6705
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  L0520 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8R7190 . This is a "BC INDIVIDUAL PROV NUM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: L0520 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0004MG . This is a "BC GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 174447601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 047623603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com