Provider Demographics
NPI:1356796155
Name:PUTHENPURAYIL, BLISS
Entity type:Individual
Prefix:
First Name:BLISS
Middle Name:
Last Name:PUTHENPURAYIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 WATERVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1400
Mailing Address - Country:US
Mailing Address - Phone:972-669-7070
Mailing Address - Fax:972-669-7017
Practice Address - Street 1:3030 WATERVIEW PKWY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1400
Practice Address - Country:US
Practice Address - Phone:972-669-7070
Practice Address - Fax:972-669-7017
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS3279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine