Provider Demographics
NPI:1083623987
Name:PURNER, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:PURNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12205 COUNTY LINE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7719
Mailing Address - Country:US
Mailing Address - Phone:256-325-4365
Mailing Address - Fax:256-461-0393
Practice Address - Street 1:12205 COUNTY LINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7719
Practice Address - Country:US
Practice Address - Phone:256-325-4365
Practice Address - Fax:256-461-0393
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00013143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL631053058027OtherTRICARE
AL009939037Medicaid
AL51536438OtherBCBS
AL631053058027OtherTRICARE
AL51536438OtherBCBS
ALP00351722Medicare PIN