Provider Demographics
NPI:1477507861
Name:PURCELL, BLAINE SMITH (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:SMITH
Last Name:PURCELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:600 8TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-6508
Mailing Address - Country:US
Mailing Address - Phone:940-676-7048
Mailing Address - Fax:940-676-3730
Practice Address - Street 1:149 HART ST
Practice Address - Street 2:
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311-3477
Practice Address - Country:US
Practice Address - Phone:940-676-7048
Practice Address - Fax:940-676-3730
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVNV-5706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXVAD-000Medicare UPIN