Provider Demographics
NPI:1093851529
Name:PURGASON, CHRISTIAN T (DO FACEP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:T
Last Name:PURGASON
Suffix:
Gender:M
Credentials:DO FACEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15473 KENT DR
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-1266
Mailing Address - Country:US
Mailing Address - Phone:530-587-3480
Mailing Address - Fax:
Practice Address - Street 1:1155 MILL ST
Practice Address - Street 2:MAIL CODE Z-11
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1576
Practice Address - Country:US
Practice Address - Phone:775-324-4040
Practice Address - Fax:775-324-4042
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9340207P00000X
NVDO1397207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDO1397OtherNEVADA OSTEOPATHIC MEDICAL LICENSE
CA20A9340OtherOSTEOPOATHIC PHYSICIAN