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Organization
JACK PURDY MD INC
Active
Organization
JACK PURDY MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK C PURDY M.D. (OWNER/ CEO PHYSCIAN AND SURGEON)
(310) 453-3533
Entity
Organization
Contact information
Practice address
17525 VENTURA BLVD STE 203, ENCINO, CA 91316-5109
(818) 986-0200
(818) 986-4393
Mailing address
17525 VENTURA BLVD STE 203, ENCINO, CA 91316-5109
(818) 986-0200
(818) 986-4393
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G31387
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G31387
STATE LICENSE
CA
Enumeration date
10/18/2007
Last updated
02/26/2010
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