Provider Demographics
NPI:1225209976
Name:CONSTANCE B PURSER MD PL
Entity Type:Organization
Organization Name:CONSTANCE B PURSER MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PURSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-361-1177
Mailing Address - Street 1:8936 77TH TER E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6419
Mailing Address - Country:US
Mailing Address - Phone:941-361-1177
Mailing Address - Fax:941-361-2422
Practice Address - Street 1:8936 77TH TER E
Practice Address - Street 2:STE 102
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-6419
Practice Address - Country:US
Practice Address - Phone:941-361-1177
Practice Address - Fax:941-361-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH23192Medicare UPIN