Provider Demographics
NPI:1982652459
Name:PURNELL, MICHAEL B (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:PURNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1335 COFFEE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3192
Mailing Address - Country:US
Mailing Address - Phone:209-524-4438
Mailing Address - Fax:209-524-7395
Practice Address - Street 1:1335 COFFEE RD
Practice Address - Street 2:#100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3192
Practice Address - Country:US
Practice Address - Phone:209-524-4438
Practice Address - Fax:209-524-7395
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA45481207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA454810Medicaid
CAOOA454810Medicaid
E30286Medicare UPIN