Provider Demographics
NPI:1548379316
Name:PURVIS, JANEY MAE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANEY
Middle Name:MAE
Last Name:PURVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6048
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6048
Mailing Address - Country:US
Mailing Address - Phone:541-382-4900
Mailing Address - Fax:541-706-2398
Practice Address - Street 1:815 SW BOND ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3593
Practice Address - Country:US
Practice Address - Phone:541-382-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR05957500OtherBCBS REGENCE
OR077490Medicaid
ORG20086OtherCHAMPUS
ORXYP187906Medicaid
ORH073533OtherPACIFIC SOURCE
ORP01071074OtherMEDICARE RAILROAD
OR05957500OtherBCBS REGENCE
ORG20086Medicare UPIN
ORR115568Medicare ID - Type UnspecifiedNORIDAN MEDICARE
ORG20086OtherCHAMPUS