MEDICARE: DR. GEORGE A. FOURAS MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	G72374	CA
2	2084P0800X	Psychiatry Physician	G72374	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	098210	OTHER		SFGH INTERNAL USE ONLY-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1770600140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE A. FOURAS MD

Provider Business Mailing Address
First Line	:	600 S COMMONWEALTH AVE FL 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-4001
Country	:	US
Telephone Number	:	213-729-2345
Fax Number	:	213-738-6521

Provider Business Practice Location Address
First Line	:	600 S COMMONWEALTH AVE FL 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-4001
Country	:	US
Telephone Number	:	213-739-2345
Fax Number	:	213-738-6521

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	11/19/2020

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