Provider Demographics
NPI:1932652633
Name:PAIN DOCTORS MD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PAIN DOCTORS MD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GURSKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-926-8444
Mailing Address - Street 1:9949 SAGE CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2327
Mailing Address - Country:US
Mailing Address - Phone:714-926-8444
Mailing Address - Fax:562-490-8599
Practice Address - Street 1:2865 ATLANTIC AVE
Practice Address - Street 2:226
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1740
Practice Address - Country:US
Practice Address - Phone:714-926-8444
Practice Address - Fax:562-490-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50055208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty