Provider Demographics
NPI:1497022677
Name:PURIFOY, LORIN (LMT)
Entity Type:Individual
Prefix:
First Name:LORIN
Middle Name:
Last Name:PURIFOY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1427 NW 23RD AVE
Practice Address - Street 2:#6
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2660
Practice Address - Country:US
Practice Address - Phone:971-227-7186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15726174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist