Provider Demographics
NPI:1962498824
Name:PURSLEY, TERRY VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:VINCENT
Last Name:PURSLEY
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 1:2504 CROCKETT DR
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5900
Mailing Address - Country:US
Mailing Address - Phone:325-646-2929
Mailing Address - Fax:325-641-0122
Practice Address - Street 1:2504 CROCKETT DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5900
Practice Address - Country:US
Practice Address - Phone:325-646-2929
Practice Address - Fax:325-641-0122
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6154207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00817KOtherMEDICARE GROUP NUMBER
TX114166503Medicaid
TX45D0488829OtherCLIA NUMBER
TX070002444OtherMEDICARE B RR PALMETTO
TX82720NMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX070002444OtherMEDICARE B RR PALMETTO