Provider Demographics
NPI:1326285537
Name:PURDY, W RANDOLPH (DO)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:RANDOLPH
Last Name:PURDY
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 1:65 PINE LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3426
Mailing Address - Country:US
Mailing Address - Phone:740-592-5063
Mailing Address - Fax:
Practice Address - Street 1:65 PINE LN
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-3426
Practice Address - Country:US
Practice Address - Phone:740-592-5063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2703207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine