# JERRY JUDD PRYDE JR MD PC

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

## Provider details

- **NPI number:** 1861766982
- **Authorized official:** DR. JERRY JUDD PRYDE JR. M.D. (OWNER)
- **Authorized official phone:** (310) 423-2182

## Contact information

- **Practice address:** 8631 WEST 3RD STREET, 915E, LOS ANGELES, CA 90048-6101
- **Practice address phone:** (310) 423-2182
- **Practice address fax:** (310) 423-0154
- **Mailing address:** 8631 WEST 3RD STREET, SUITE 915E, LOS ANGELES, CA 90048-6101
- **Mailing address phone:** (310) 423-2182
- **Mailing address fax:** (310) 423-0154

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/07/2012
- **Last updated:** 03/07/2012