Individual
DR. AJITH PURUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS, MD
Contact information
Practice address
722 N MONTEZUMA ST, PRESCOTT, AZ 86301-2002
(928) 237-9000
(928) 237-9011
Mailing address
722 N MONTEZUMA ST, PRESCOTT, AZ 86301-2002
(928) 237-9000
(928) 237-9011
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
33680
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101416
MEDICARE ID
AZ
01
—
P00217872
RR MEDICARE
—
Enumeration date
09/27/2005
Last updated
01/28/2015
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