Provider Demographics
NPI:1659556231
Name:PURDY, KIT ERICA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KIT
Middle Name:ERICA
Last Name:PURDY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1458
Mailing Address - Country:US
Mailing Address - Phone:512-324-7516
Mailing Address - Fax:512-324-7536
Practice Address - Street 1:601 E 15TH ST
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1930
Practice Address - Country:US
Practice Address - Phone:512-324-7516
Practice Address - Fax:512-324-7536
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9587207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194689904Medicaid
TX194689903Medicaid
TX8L18584Medicare PIN
TX8L18614Medicare PIN
TX194689903Medicaid
TX194689904Medicaid