Provider Demographics
NPI:1043241441
Name:PUREWAL, DALBIR S (MD)
Entity Type:Individual
Prefix:DR
First Name:DALBIR
Middle Name:S
Last Name:PUREWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18220 TOMBALL PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4347
Mailing Address - Country:US
Mailing Address - Phone:281-737-0570
Mailing Address - Fax:281-807-6024
Practice Address - Street 1:18220 TOMBALL PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4347
Practice Address - Country:US
Practice Address - Phone:281-737-0570
Practice Address - Fax:281-807-6024
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043241441OtherNPI PROVIDER #
TX042938303Medicaid
TX042938301Medicaid
TX042938302Medicaid
TX1043241441OtherBLUE CROSS BLUE SHIELD
TX8DT626OtherBLUE CROSS BLUE SHIELD
TXP01114503OtherRR MEDICARE
TX8DF830OtherBLUE CROSS BLUE SHIELD
TXTXB156433Medicare PIN
TX8DF830OtherBLUE CROSS BLUE SHIELD
TX8DT626OtherBLUE CROSS BLUE SHIELD
TX042938302Medicaid
TX293577YMVQMedicare PIN