Provider Demographics
NPI:1528166832
Name:PURDY, WALLACE B (MD)
Entity type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:B
Last Name:PURDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:513 BROOKWOOD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5807
Mailing Address - Country:US
Mailing Address - Phone:205-250-8100
Mailing Address - Fax:205-783-5176
Practice Address - Street 1:513 BROOKWOOD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5807
Practice Address - Country:US
Practice Address - Phone:205-250-8100
Practice Address - Fax:205-783-5176
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051526684Medicaid
AL051526684Medicaid
ALG19990Medicare UPIN