Provider Demographics
NPI:1689607350
Name:PURGHOL, MARWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARWAN
Middle Name:
Last Name:PURGHOL
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:PO BOX 1283
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-1283
Mailing Address - Country:US
Mailing Address - Phone:409-729-6700
Mailing Address - Fax:409-729-6705
Practice Address - Street 1:3000 39TH ST
Practice Address - Street 2:SUITE103
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5517
Practice Address - Country:US
Practice Address - Phone:409-729-6700
Practice Address - Fax:409-729-6705
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL05202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R7190OtherBC INDIVIDUAL PROV NUM
TXL0520OtherMEDICAL LICENSE
TX0004MGOtherBC GROUP NUMBER
TX174447601Medicaid
TX047623603Medicaid
TX00248YMedicare ID - Type UnspecifiedMEDICARE GROUP
TX8R7190OtherBC INDIVIDUAL PROV NUM
TX174447601Medicaid