Provider Demographics
NPI:1780759597
Name:ROD PURDIE M D P C
Entity type:Organization
Organization Name:ROD PURDIE M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:N
Authorized Official - Last Name:PURDIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-518-5332
Mailing Address - Street 1:3222 EAST 93RD ST.
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137
Mailing Address - Country:US
Mailing Address - Phone:918-518-5332
Mailing Address - Fax:
Practice Address - Street 1:3222 E 93RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-3639
Practice Address - Country:US
Practice Address - Phone:918-518-5332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK190982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty