Provider Demographics
NPI:1093767030
Name:PURDOM, CHAD J (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:J
Last Name:PURDOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6101 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3900
Mailing Address - Country:US
Mailing Address - Phone:239-304-4862
Mailing Address - Fax:239-304-5157
Practice Address - Street 1:6101 PINE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3900
Practice Address - Country:US
Practice Address - Phone:239-348-4000
Practice Address - Fax:239-304-5157
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLFLME0092645207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272595900Medicaid
FL272595900Medicaid