Individual
DR. TERRY VINCENT PURSLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2504 CROCKETT DR, BROWNWOOD, TX 76801-5900
(325) 646-2929
(325) 641-0122
Mailing address
2504 CROCKETT DR, BROWNWOOD, TX 76801-5900
(325) 646-2929
(325) 641-0122
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
E6154
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00817K
MEDICARE GROUP NUMBER
TX
01
—
070002444
MEDICARE B RR PALMETTO
TX
05
—
114166503
—
TX
01
—
45D0488829
CLIA NUMBER
TX
Enumeration date
09/26/2005
Last updated
10/23/2007
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