# JACK PURDY MD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154510899
- **Authorized official:** JACK C PURDY M.D. (OWNER/ CEO PHYSCIAN AND SURGEON)
- **Authorized official phone:** (310) 453-3533

## Contact information

- **Practice address:** 17525 VENTURA BLVD STE 203, ENCINO, CA 91316-5109
- **Practice address phone:** (818) 986-0200
- **Practice address fax:** (818) 986-4393
- **Mailing address:** 17525 VENTURA BLVD STE 203, ENCINO, CA 91316-5109
- **Mailing address phone:** (818) 986-0200
- **Mailing address fax:** (818) 986-4393

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | G31387 | CA | Yes |

## Other

- **Enumeration date:** 10/18/2007
- **Last updated:** 02/26/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | G31387 | STATE LICENSE | CA |