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NPI Code Detail

MEDICARE: PHILLIP JORGE MD INC

MEDICARE: PHILLIP JORGE MD INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207LP2900XPain Medicine (Anesthesiology) PhysicianG78921CA
2207L00000XAnesthesiology PhysicianG78921CA

General Provider Information

NPI Number : 1073574000
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHILLIP JORGE MD INC
Provider Business Mailing Address
First Line : PO BOX 7001
Second Line :
City : TARZANA
State : CA
Zip : 91357-7001
Country : US
Telephone Number : 818-888-7815
Fax Number : 818-715-1722
Provider Business Practice Location Address
First Line : 3828 DELMAS TER
Second Line :
City : CULVER CITY
State : CA
Zip : 90232-2713
Country : US
Telephone Number : 310-836-7000
Fax Number : 818-715-1722
Authorized Official
Title or Position : DIRECT OWNER
Name : PHILLIP JORGE
Credential : M.D.
Telephone Number : 818-888-7815
Provider Enumeration Date : 03/29/2006
Last Update Date : 09/22/2009

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