Provider Demographics
NPI:1629381751
Name:EDWARD A. PURO, M.D.P.C.
Entity Type:Organization
Organization Name:EDWARD A. PURO, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PURO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-838-0222
Mailing Address - Street 1:11115 NEW HALLS FERRY RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-7613
Mailing Address - Country:US
Mailing Address - Phone:314-838-0222
Mailing Address - Fax:314-838-0234
Practice Address - Street 1:11115 NEW HALLS FERRY RD
Practice Address - Street 2:SUITE 306
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-7613
Practice Address - Country:US
Practice Address - Phone:314-838-0222
Practice Address - Fax:314-838-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7135261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201874203Medicaid
MO201874203Medicaid
MOA09866Medicare UPIN