Provider Demographics
NPI:1720320336
Name:PURVIS, BUDDY LEE
Entity Type:Individual
Prefix:
First Name:BUDDY
Middle Name:LEE
Last Name:PURVIS
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 1:1814 CAL YOUNG RD APT 92
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2018
Mailing Address - Country:US
Mailing Address - Phone:541-214-4967
Mailing Address - Fax:
Practice Address - Street 1:1814 CAL YOUNG RD APT 92
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2018
Practice Address - Country:US
Practice Address - Phone:541-214-4967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT-19235225700000X
OR19235174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist