Provider Demographics
NPI:1922066257
Name:PURDY, ALAN DALE (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:DALE
Last Name:PURDY
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 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:5011 W LOWELL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-8587
Practice Address - Country:US
Practice Address - Phone:509-385-0610
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1665801Medicaid
WAA07353Medicare UPIN
WA00301278Medicare ID - Type Unspecified