Provider Demographics
NPI:1720067846
Name:PURPORA, DAVID P (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:PURPORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16329 S. TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-949-7246
Mailing Address - Fax:239-949-7236
Practice Address - Street 1:16329 S. TAMIAMI TRAIL
Practice Address - Street 2:SOUTHWEST FLORIDA MEDICAL
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-949-7246
Practice Address - Fax:239-949-7236
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT017804174400000X, 207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No174400000XOther Service ProvidersSpecialist
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004212932Medicaid
CT004212932Medicaid
CTB84370Medicare UPIN