Healthcare Provider Details

I. General information

NPI: 1891173068
Provider Name (Legal Business Name): BIG SUR ANESTHESIA GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81812 DOCTOR CARREON BLVD SUITE F
INDIO CA
92201-0607
US

IV. Provider business mailing address

5665 NEW NORTHSIDE DR SUITE 320
ATLANTA GA
30328-5831
US

V. Phone/Fax

Practice location:
  • Phone: 760-775-2225
  • Fax:
Mailing address:
  • Phone: 770-874-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER BRIAN DURHAM
Title or Position: PRESIDENT
Credential:
Phone: 770-874-5400