Provider Demographics
NPI:1437282134
Name:PURDOM, DAVID G (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:PURDOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1197
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1197
Mailing Address - Country:US
Mailing Address - Phone:812-385-9392
Mailing Address - Fax:812-385-9263
Practice Address - Street 1:1808 SHERMAN DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1043
Practice Address - Country:US
Practice Address - Phone:812-385-9392
Practice Address - Fax:812-385-9263
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR0617208600000X
IN01069414A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100018190Medicaid
OH2757155Medicaid
KY0365005Medicare PIN
KY7100018190Medicaid
KYP00436970Medicare PIN
KY0957506Medicare PIN
INM400041885Medicare PIN