MEDICARE: RICHARD BRUCE JURMAIN M.D.

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
1	207RC0000X	Cardiovascular Disease Physician	A22905	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	061986708	OTHER	CA	RAILROAD MEDICARE PROV #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174555775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD BRUCE JURMAIN M.D.

Provider Business Mailing Address
First Line	:	9808 VENICE BLVD
Second Line	:	SUITE 503
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2732
Country	:	US
Telephone Number	:	310-815-1650
Fax Number	:

Provider Business Practice Location Address
First Line	:	9808 VENICE BLVD
Second Line	:	SUITE 503
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2732
Country	:	US
Telephone Number	:	310-815-1650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/09/2010

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