Provider Demographics
NPI:1245290204
Name:JURIGA, BRIAN JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:JURIGA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29804 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-4611
Mailing Address - Country:US
Mailing Address - Phone:440-833-2010
Mailing Address - Fax:
Practice Address - Street 1:29804 LAKESHORE BLVD.
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095
Practice Address - Country:US
Practice Address - Phone:440-833-2010
Practice Address - Fax:440-833-2096
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008540207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH264200000OtherFEDERAL BLACK LUNG
OH341425870042OtherMEDICAL MUTUAL OF OHIO
OH6600162OtherUNITED HEALTHCARE
OH264200000OtherDEPT OF LABOR
OH000000385887OtherANTHEM
OH6600162OtherUNITED HEALTHCARE
OH000000385887OtherANTHEM