Provider Demographics
NPI:1235241183
Name:PURCELL, DAVE M (MD)
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:M
Last Name:PURCELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TRILLIUM WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8445
Mailing Address - Country:US
Mailing Address - Phone:606-523-2140
Mailing Address - Fax:606-523-2547
Practice Address - Street 1:TRILLIUM WAY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701
Practice Address - Country:US
Practice Address - Phone:606-528-1212
Practice Address - Fax:606-523-2547
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29617207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64296171Medicaid
KY000000184059OtherANTHEM
KY0880804Medicare ID - Type Unspecified
KY0229015Medicare ID - Type Unspecified
KY0666905Medicare ID - Type Unspecified
KY64296171Medicaid