Provider Demographics
NPI:1427071919
Name:PURVIS, THOMAS L JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:PURVIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 SGT PRENTISS DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4792
Mailing Address - Country:US
Mailing Address - Phone:601-442-3701
Mailing Address - Fax:601-442-4785
Practice Address - Street 1:46 SGT PRENTISS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4792
Practice Address - Country:US
Practice Address - Phone:601-442-3701
Practice Address - Fax:601-442-4785
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05717207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115423Medicaid
LA1104604Medicaid
MS00115423Medicaid
MS160000110Medicare ID - Type Unspecified