Provider Demographics
NPI:1538300801
Name:PURPLE LIGHT ENDO, PLLC
Entity Type:Organization
Organization Name:PURPLE LIGHT ENDO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIPITI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAVISHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-540-0000
Mailing Address - Street 1:PO BOX 741126
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77274-1126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10005 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5209
Practice Address - Country:US
Practice Address - Phone:713-532-7311
Practice Address - Fax:713-532-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008568261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical