Provider Demographics
NPI:1629063474
Name:PURVIS, WILLIAM HENRY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:PURVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 CARTHAGE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4111
Mailing Address - Country:US
Mailing Address - Phone:919-775-7232
Mailing Address - Fax:919-775-1731
Practice Address - Street 1:1139 CARTHAGE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4111
Practice Address - Country:US
Practice Address - Phone:919-775-7232
Practice Address - Fax:919-775-1731
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18702208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C81000Medicare UPIN
NC201984EMedicare PIN