Provider Demographics
NPI:1356097075
Name:PURYEAR, TERRY M
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:M
Last Name:PURYEAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2771 PALOMA SENDA
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7982
Mailing Address - Country:US
Mailing Address - Phone:928-577-7173
Mailing Address - Fax:928-219-5371
Practice Address - Street 1:2771 PALOMA SENDA
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7982
Practice Address - Country:US
Practice Address - Phone:928-577-7173
Practice Address - Fax:928-219-5371
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23147898