Healthcare Provider Details

I. General information

NPI: 1710063573
Provider Name (Legal Business Name): GREGORY J JURKOVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 STOCKTON BLVD., CYPRESS TRAUMA SURGERY CLINIC SUITE E
SACRAMENTO CA
95817-1418
US

IV. Provider business mailing address

2221 STOCKTON BLVD., CYPRESS BLDG. 3RD FLOOR SUITE 3111
SACRAMENTO CA
95817-1418
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3510
  • Fax: 916-734-7089
Mailing address:
  • Phone: 916-734-3510
  • Fax: 916-734-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD00025766
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD00025766
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD00025766
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number141002
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number141002
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number141002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: