Provider Demographics
NPI:1689283780
Name:PURVIS, GREGORY JR
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:PURVIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 PARKWOODS CT
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7425
Mailing Address - Country:US
Mailing Address - Phone:405-600-5258
Mailing Address - Fax:
Practice Address - Street 1:1305 PARKWOODS CT
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7425
Practice Address - Country:US
Practice Address - Phone:405-600-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist