Provider Demographics
NPI:1891173068
Name:BIG SUR ANESTHESIA GROUP, PC
Entity Type:Organization
Organization Name:BIG SUR ANESTHESIA GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-874-5400
Mailing Address - Street 1:5665 NEW NORTHSIDE DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5831
Mailing Address - Country:US
Mailing Address - Phone:770-874-5400
Mailing Address - Fax:
Practice Address - Street 1:81812 DOCTOR CARREON BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-0607
Practice Address - Country:US
Practice Address - Phone:760-775-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty