Provider Demographics
NPI:1568683910
Name:PURDUE, PATRICK C (DOM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:C
Last Name:PURDUE
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14284 NEPTUNE RD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-1047
Mailing Address - Country:US
Mailing Address - Phone:727-319-8819
Mailing Address - Fax:727-319-8320
Practice Address - Street 1:10010 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2538
Practice Address - Country:US
Practice Address - Phone:727-319-8819
Practice Address - Fax:727-319-8320
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP760171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist