Provider Demographics
NPI:1184651838
Name:PURCELL, CHRISTOPHER J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:PURCELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:12780 RACE TRACK RD STE 300
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1306
Practice Address - Country:US
Practice Address - Phone:813-792-9541
Practice Address - Fax:813-443-8170
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME60926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373376900Medicaid
F24880Medicare UPIN