Provider Demographics
NPI:1669436739
Name:PURVINES, SCOTT H (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:H
Last Name:PURVINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:P O BOX 504178
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-0001
Mailing Address - Country:US
Mailing Address - Phone:314-878-2888
Mailing Address - Fax:314-576-8187
Practice Address - Street 1:232 S WOODS MILL RD
Practice Address - Street 2:SUITE 400 EAST
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3417
Practice Address - Country:US
Practice Address - Phone:314-878-2888
Practice Address - Fax:314-576-8187
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20050087725207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207361007Medicaid
MO207361007Medicaid
MO008014649Medicare PIN