Provider Demographics
NPI:1609831924
Name:PURSER, PHILIP ASHLEY (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:ASHLEY
Last Name:PURSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATT: MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:6310 HEALTH PARK WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5177
Practice Address - Country:US
Practice Address - Phone:941-373-6534
Practice Address - Fax:941-373-6532
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-2087612085R0001X
FLME1010612085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4614188Medicaid
FL261114700Medicaid
MIN66670005Medicare ID - Type Unspecified
FL261114700Medicaid
FL58827WMedicare PIN