Individual
DR. HENRY PURCELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6812 STATE ROUTE 162 STE 121, MARYVILLE, IL 62062-8586
(618) 391-6910
Mailing address
PO BOX 797021, SAINT LOUIS, MO 63179-7000
(314) 644-3535
(314) 644-3255
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
R9H62
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110165961
RAILROAD MEDICARE
MO
Enumeration date
11/01/2006
Last updated
09/10/2024
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