Provider Demographics
NPI:1770529620
Name:KURGIS, BRADLEY S (DO)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:S
Last Name:KURGIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1320 LAS TABLAS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9711
Mailing Address - Country:US
Mailing Address - Phone:805-434-5563
Mailing Address - Fax:805-434-5916
Practice Address - Street 1:1320 LAS TABLAS RD
Practice Address - Street 2:SUITE B
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9711
Practice Address - Country:US
Practice Address - Phone:805-434-5563
Practice Address - Fax:805-434-5916
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5517207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA002A55170OtherBLUE SHIELD
CAE95796Medicare UPIN
CA20A55170Medicare ID - Type UnspecifiedMEDICARE