Provider Demographics
NPI:1376537639
Name:JURIS, ANDREW LESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LESTER
Last Name:JURIS
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 1:5609 J ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3957
Mailing Address - Country:US
Mailing Address - Phone:916-452-5391
Mailing Address - Fax:916-452-7471
Practice Address - Street 1:5609 J ST
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3957
Practice Address - Country:US
Practice Address - Phone:916-452-5391
Practice Address - Fax:916-452-7471
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA364172080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A364170Medicaid
CAZZZ00672ZMedicare ID - Type Unspecified
CA00A364170Medicaid