Provider Demographics
NPI:1366736290
Name:BRADLEY S KURGIS D O INC
Entity type:Organization
Organization Name:BRADLEY S KURGIS D O INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KURGIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:805-434-5563
Mailing Address - Street 1:1320 LAS TABLAS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9711
Mailing Address - Country:US
Mailing Address - Phone:805-434-5563
Mailing Address - Fax:805-434-5916
Practice Address - Street 1:1320 LAS TABLAS RD
Practice Address - Street 2:SUITE B
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9711
Practice Address - Country:US
Practice Address - Phone:805-434-5563
Practice Address - Fax:805-434-5916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A55170OtherMEDICARE ID
CA20A55170OtherMEDICARE ID