Provider Demographics
NPI:1346970688
Name:PURNIA, GEORGE H JR
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:H
Last Name:PURNIA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 E GRAYSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78208-1013
Mailing Address - Country:US
Mailing Address - Phone:210-225-4516
Mailing Address - Fax:
Practice Address - Street 1:818 E GRAYSON ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78208-1013
Practice Address - Country:US
Practice Address - Phone:210-225-4516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246YC3302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246YC3302XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationCoding Specialist, Physician Office Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1760932081Medicaid