Provider Demographics
NPI:1215922497
Name:PURDY, JONATHAN B (DPM)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:B
Last Name:PURDY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1100 ANDRE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2159
Mailing Address - Country:US
Mailing Address - Phone:337-256-8494
Mailing Address - Fax:337-256-8945
Practice Address - Street 1:1100 ANDRE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2159
Practice Address - Country:US
Practice Address - Phone:337-256-8494
Practice Address - Fax:337-256-8945
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAPD323R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1464635Medicaid
LAJ5468OtherBLUE CROSS BLUE SHIELD
453278920OtherTRICARE