Provider Demographics
NPI:1346261302
Name:JURIC, GORDON (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:JURIC
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 1:163 LIBBEY INDUSTRIAL PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3137
Mailing Address - Country:US
Mailing Address - Phone:781-337-4224
Mailing Address - Fax:781-335-0429
Practice Address - Street 1:163 LIBBEY INDUSTRIAL PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3137
Practice Address - Country:US
Practice Address - Phone:781-337-4224
Practice Address - Fax:781-335-0429
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75606207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF26097OtherTRICARE
MA275178OtherHARVARD PILGRIM
MA3092305Medicaid
MAJ12427OtherBLUE SHIELD
MA075605OtherTUFTS HEALTH PLAN
MA050049692OtherPALMETTO GBA
MA364770OtherFALLON
MA3092305OtherHEALTHY START
MAF26097Medicare UPIN
MAJ12427Medicare PIN
MA050049692OtherPALMETTO GBA
MA364770OtherFALLON