Provider Demographics
NPI:1326227901
Name:PURCELL, JOSEPH PATRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:PURCELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 SHASTA ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0443
Mailing Address - Country:US
Mailing Address - Phone:530-244-4608
Mailing Address - Fax:530-247-1096
Practice Address - Street 1:1945 SHASTA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0443
Practice Address - Country:US
Practice Address - Phone:530-244-4608
Practice Address - Fax:530-247-1096
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245815208100000X
CA20A10323208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ58464YOtherBLUE SHIELD
CABT342XMedicare PIN
BT342YMedicare PIN