Provider Demographics
NPI:1609054139
Name:FURMAN MEDICAL CORPORATION
Entity Type:Organization
Organization Name:FURMAN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-535-1772
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91102-0312
Mailing Address - Country:US
Mailing Address - Phone:626-535-1772
Mailing Address - Fax:626-535-1776
Practice Address - Street 1:630 S RAYMOND AVE
Practice Address - Street 2:#240
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3278
Practice Address - Country:US
Practice Address - Phone:626-535-1772
Practice Address - Fax:626-535-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA492470207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ51023YOtherBLUE SHIELD GROUP
CAZZZ51023YOtherBLUE SHIELD GROUP