Provider Demographics
NPI:1063468635
Name:PURGETT, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:PURGETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 GRAYSON DR APT 517
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7002
Mailing Address - Country:US
Mailing Address - Phone:817-919-9165
Mailing Address - Fax:
Practice Address - Street 1:2300 GRAYSON DR APT 517
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7002
Practice Address - Country:US
Practice Address - Phone:817-919-9165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3833208600000X
CAC167473208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC167473OtherCA STATE MEDICAL LICENSE
TXH3833OtherSTATE MEDICAL LICENSE
TX104970201Medicaid
TX104970201Medicaid