Provider Demographics
NPI:1245325984
Name:POURZAN, CYRUS ANDRIS (MD)
Entity type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:ANDRIS
Last Name:POURZAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:52 N TU SU LN
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-8058
Mailing Address - Country:US
Mailing Address - Phone:760-873-6111
Mailing Address - Fax:760-872-8152
Practice Address - Street 1:1150 S. GOODWIN RD
Practice Address - Street 2:
Practice Address - City:LONE PINE
Practice Address - State:CA
Practice Address - Zip Code:93545
Practice Address - Country:US
Practice Address - Phone:760-876-4795
Practice Address - Fax:760-876-5624
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV4876208D00000X
CAG46209208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CS45082Medicare UPIN