Healthcare Provider Details

I. General information

NPI: 1366736290
Provider Name (Legal Business Name): BRADLEY S KURGIS D O INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 LAS TABLAS RD SUITE B
TEMPLETON CA
93465-9711
US

IV. Provider business mailing address

1320 LAS TABLAS RD SUITE B
TEMPLETON CA
93465-9711
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-5563
  • Fax: 805-434-5916
Mailing address:
  • Phone: 805-434-5563
  • Fax: 805-434-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY S KURGIS
Title or Position: OWNER
Credential: DO
Phone: 805-434-5563