Provider Demographics
NPI:1417182593
Name:PURKEY, MICHAEL TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TIMOTHY
Last Name:PURKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:365 LENNON LN
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5910
Mailing Address - Country:US
Mailing Address - Phone:925-948-8143
Mailing Address - Fax:925-215-4540
Practice Address - Street 1:2581 SAMARITAN DR
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4113
Practice Address - Country:US
Practice Address - Phone:408-442-5090
Practice Address - Fax:408-442-5091
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA128700207Y00000X
PAMT195433390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA149198Medicare PIN