Provider Demographics
NPI:1942349592
Name:PURDY, NAOMI C (MD)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:C
Last Name:PURDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3227 E WARM SPRINGS RD
Mailing Address - Street 2:STE 300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3180
Mailing Address - Country:US
Mailing Address - Phone:702-222-0034
Mailing Address - Fax:702-222-0659
Practice Address - Street 1:9010 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8932
Practice Address - Country:US
Practice Address - Phone:702-240-8646
Practice Address - Fax:702-240-0206
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO28220OtherMO BLUE SHIELD
AR98624OtherAR BLUE SHIELD
MO203646435Medicaid
MO203646435Medicaid
MO330733230Medicare PIN
AR98624OtherAR BLUE SHIELD