Provider Demographics
NPI:1598865206
Name:PURDY, JAMES JOHN (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOHN
Last Name:PURDY
Suffix:
Gender:M
Credentials:MD, FACOG
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:JOHN
Other - Last Name:PURDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, FACOG
Mailing Address - Street 1:1221 24TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301
Mailing Address - Country:US
Mailing Address - Phone:601-485-2609
Mailing Address - Fax:601-482-1190
Practice Address - Street 1:1221 24TH AVENUE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-485-2609
Practice Address - Fax:601-482-1190
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07434207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115336Medicaid
C48034Medicare UPIN
MS00115336Medicaid