Provider Demographics
NPI:1245290741
Name:PURO, DAVID M (MD, FACC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:PURO
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JOHNSON AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4154
Mailing Address - Country:US
Mailing Address - Phone:805-782-8844
Mailing Address - Fax:805-782-8859
Practice Address - Street 1:1941 JOHNSON AVE
Practice Address - Street 2:STE 101
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4154
Practice Address - Country:US
Practice Address - Phone:805-782-8844
Practice Address - Fax:805-782-8859
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56853207RC0000X, 207UN0901X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28458ZOtherBLUE SHIELD
CA00G568530Medicaid
CA060058888OtherRAILROAD MEDICARE
CAWG56853MMedicare PIN
CAWG56853GMedicare PIN
CAWG56853FMedicare PIN
CAWG56853EMedicare PIN
CA00G568530Medicaid
CAD74251Medicare UPIN
CAWG56853EMedicare PIN
CAWG56853HMedicare PIN
CAWG56853GMedicare PIN