Provider Demographics
NPI:1922055763
Name:PURSLEY, HOLLY GLUTH (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:GLUTH
Last Name:PURSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 HOSPITAL DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532
Mailing Address - Country:US
Mailing Address - Phone:251-990-1740
Mailing Address - Fax:251-990-1741
Practice Address - Street 1:188 HOSPITAL DR
Practice Address - Street 2:SUITE 402
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-990-1740
Practice Address - Fax:251-990-1741
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG9993Medicare UPIN