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General NPI Number Information
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NPI Number | 1932652633
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Entity Type | Organization
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Legal Business Name | PAIN DOCTORS MD MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 2865 ATLANTIC AVE 226
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City | LONG BEACH
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State | CA
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Zip | 90806-1740
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Country | US
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Telephone | 714-926-8444
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Fax | 562-490-8599
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Provider Business Mailing Address
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Address Line | 9949 SAGE CIR
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-2327
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Country | US
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Telephone | 714-926-8444
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Fax | 562-490-8599
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN R GURSKIS
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Credential | MD
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Telephone | 714-926-8444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | G50055
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License Number State | CA
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