Healthcare Provider Details

I. General information

NPI: 1275875312
Provider Name (Legal Business Name): LOUIS J LURIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 11/30/2021
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 MALL VIEW RD
BAKERSFIELD CA
93306-3050
US

IV. Provider business mailing address

5055 CALIFORNIA AVE STE 300
BAKERSFIELD CA
93309-0712
US

V. Phone/Fax

Practice location:
  • Phone: 661-334-2995
  • Fax: 661-334-2994
Mailing address:
  • Phone: 661-334-2009
  • Fax: 877-744-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA139869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: