Provider Demographics
NPI:1043702699
Name:C. MICHAEL PURMER MD INC
Entity Type:Organization
Organization Name:C. MICHAEL PURMER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SERIANNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-480-2600
Mailing Address - Street 1:1000 NEWBURY RD STE 180
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6440
Mailing Address - Country:US
Mailing Address - Phone:805-480-2600
Mailing Address - Fax:805-480-2677
Practice Address - Street 1:1000 NEWBURY RD STE 180
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-6440
Practice Address - Country:US
Practice Address - Phone:805-480-2600
Practice Address - Fax:805-480-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74571207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTIN CORPORATION