Provider Demographics
NPI:1750500419
Name:PURCELL FAMILY PRACTICE INC
Entity type:Organization
Organization Name:PURCELL FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:DYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-527-5400
Mailing Address - Street 1:1401 N 4TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-1806
Mailing Address - Country:US
Mailing Address - Phone:405-527-5400
Mailing Address - Fax:405-527-7332
Practice Address - Street 1:1401 N 4TH ST
Practice Address - Street 2:STE 201
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1806
Practice Address - Country:US
Practice Address - Phone:405-527-5400
Practice Address - Fax:405-527-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK893340003001OtherBCBS OF OK
OKDN7963OtherRAILROAD MEDICARE
OK200195930AMedicaid
OK900522587Medicare PIN