Provider Demographics
NPI:1467640870
Name:THOMAS J. PURGASON, M.D., P.A.
Entity Type:Organization
Organization Name:THOMAS J. PURGASON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PURGASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-465-8855
Mailing Address - Street 1:3600 MATLOCK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3679
Mailing Address - Country:US
Mailing Address - Phone:817-465-8855
Mailing Address - Fax:
Practice Address - Street 1:3600 MATLOCK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-3679
Practice Address - Country:US
Practice Address - Phone:817-465-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00SE16Medicare PIN
TXB25697Medicare UPIN