Provider Demographics
NPI:1942811815
Name:PURI, BIRENDRA
Entity type:Individual
Prefix:
First Name:BIRENDRA
Middle Name:
Last Name:PURI
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 1:908 MARIETTA LN
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1256
Mailing Address - Country:US
Mailing Address - Phone:972-804-6465
Mailing Address - Fax:
Practice Address - Street 1:2310 W UNIVERSITY DR STE 1500
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-1650
Practice Address - Country:US
Practice Address - Phone:940-220-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA16120363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant