Provider Demographics
NPI:1992773675
Name:PURDY, CHARLES R (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:PURDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:773-348-1281
Mailing Address - Fax:901-227-3206
Practice Address - Street 1:1523 22ND AVE STE B
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4016
Practice Address - Country:US
Practice Address - Phone:601-703-8450
Practice Address - Fax:601-553-6308
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS18829207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07375770Medicaid
I10917Medicare UPIN