Provider Demographics
NPI:1013100742
Name:PURCELL, ANNIE DAVIDSON (DO)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:DAVIDSON
Last Name:PURCELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 992316
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-2316
Mailing Address - Country:US
Mailing Address - Phone:530-244-4608
Mailing Address - Fax:530-247-1096
Practice Address - Street 1:1945 SHASTA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0443
Practice Address - Country:US
Practice Address - Phone:530-244-4608
Practice Address - Fax:530-247-1096
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10303208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ58464YOtherBLUE SHIELD
CAZZZ58464YOtherBLUE SHIELD