Provider Demographics
NPI:1821324682
Name:TERRY J. DUBROW A MEDICAL CORP
Entity Type:Organization
Organization Name:TERRY J. DUBROW A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:DUBROW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-515-4111
Mailing Address - Street 1:1617 WESTCLIFF DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5525
Mailing Address - Country:US
Mailing Address - Phone:949-515-4111
Mailing Address - Fax:949-515-0318
Practice Address - Street 1:1617 WESTCLIFF DR STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5525
Practice Address - Country:US
Practice Address - Phone:949-515-4111
Practice Address - Fax:949-515-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62109208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty